Reimbursement

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

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One of the primary means of performing billable services is through ‘incident-to’ billing.
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Pharmacies can generate an average of $8800 per month from services such as consultations, educational classes, and immunizations.
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Using the 2012 to 2017 Medicare Part D Drug Event and Medicaid Spending and Utilization data sets, the researchers analyzed 20 extended-release drugs with 37 Medicare formulations and 36 Medicaid formulations. The analyses were conducted from January to December 2019.
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The National Community Pharmacists Association, the Arkansas Pharmacists Association, the American Pharmacists Association, and the National Alliance of State Pharmacy Associations took the joint action of filing an amicus brief in the Supreme Court case [Arkansas Attorney General Leslie] Rutledge v. the Pharmaceutical Care Management Association, scheduled to be heard in Washington, DC on April 27, 2020.
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Specialty pharmacies can provide seamless support across specialty mail and retail channels.
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According to a new report from the Leonard D. Schaeffer Center for Health Policy and Economics, a $1 increase in drug rebates was associated with a $1.17 rise in list prices, hurting uninsured patients who pay list prices and insured patients who pay coinsurance and deductibles based on list prices.
 
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As the Supreme Court prepares to hear oral arguments in Rutledge v. Pharmaceutical Care Management Association (PCMA), several states are moving forward with their own legislation to limit the influence of pharmacy benefit managers (PBMs) in managed care organizations.
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Specialty medications also are the fastest growing cost component of total health care costs.
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Over the past 30 years, health plans have changed from primarily conventional health care coverage to alternatives such as health maintenance organizations and, most recently, high deductible health plans.
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In the current chaotic environment of reimbursement that depends on quality and cost savings, pharmacists should increase their presence.
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Study suggests that the ACA improved financial risk protection against medical bills for low-income adults.
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These changes would lower the beneficiary cost sharing on more expensive prescription drugs, promote the use of generic medications, and allow beneficiaries to know in advance and compare their out-of-pocket payments for different prescription drugs.