Reimbursement

Specialty medications also are the fastest growing cost component of total health care costs.

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.

In the current chaotic environment of reimbursement that depends on quality and cost savings, pharmacists should increase their presence.

Study suggests that the ACA improved financial risk protection against medical bills for low-income adults.

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.

Girish Dighe, PharmD, MS, discusses pharmacy's role in a health system's financial performance. 

A new report from the Florida Pharmacy Association and American Pharmacy Cooperative, Inc, alleges that pharmacy benefit managers (PBMs) in the state are favoring their own affiliated pharmacies in the Florida Medicaid Program, both by driving customers to those pharmacies and by reimbursing them at higher rates.

Several viable models continue to emerge for addressing the unique challenges of payment and financing for innovative, durable, curative gene and cell therapies.

Girish Dighe, PharmD, MS, discusses important partnerships within a health system looking to achieve revenue integrity. 

Electronic health records and the data created are being used on multiple levels and continue to be a driving force for improving care and lowering health care costs.
 

Mark Vogler, RPh, is the owner of Martin-Tipton Pharmacy in Amarillo, TX. It is a high-volume pharmacy, doing about twice as many prescriptions per day as the national average.

Proposal seeks to provide different benefits and more stringent requirements than traditional Medicaid.