Reimbursement

The Pharmacy Times® Reimbursement resource center provides clinical news and articles, information about reimbursement for clinical pharmacy services.

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Multiple pharmacies recently received letters from ESI stating that on behalf of TRICARE and the Defense Health Agency, ESI was recouping money for compound drug claims submitted in 2015.
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According to the investigators, payers and employers are increasingly adopting HDHPs in an effort to control rising health care costs.
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A recent qualitative study presented a potential explanation for why health system specialty pharmacies often find it difficult to partner with payers.
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Although some of the largest insurers have waived their cost sharing requirements, employer-sponsored “self-insured” health insurance plans are not required to adhere to these waivers.
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According to a new study by West Health and Gallup, 88% of US adults support the federal government directly negotiating the price of a COVID-19 treatment with a drug manufacturer upon its availability due to concerns regarding raised drug prices.
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With the evolution and growth of specialty pharmacies, so too did services provided by hubs and the places where they were situated.
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Specialty pharmacy is beginning to implement its own set of strategies in order to manage the cost of one of the most expensive sectors of the pharmaceutical industry.
 
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The US Senate recently passed the Paycheck Protection Program Flexibility Act after its quick success in the House last week.
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Artificial intelligence will inevitably play a major role in hub services, improving efficiency and speed to therapy.
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Pharma companies that shift their attention to what providers, payers, and patients are asking for will profit from the growing worldwide market on preventative care.
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In an era of high-priced drugs, health care stakeholders continue to explore alternative pricing models that focus on the concept of value-based drug purchasing models.
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At minimum, they should engage in compliance risks; financial opportunities; key advocacy efforts; and program resources, structure, and value.