Reimbursement

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.

According to the investigators, payers and employers are increasingly adopting HDHPs in an effort to control rising health care costs.

A recent qualitative study presented a potential explanation for why health system specialty pharmacies often find it difficult to partner with payers.

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.

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.

With the evolution and growth of specialty pharmacies, so too did services provided by hubs and the places where they were situated.

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.
 

The US Senate recently passed the Paycheck Protection Program Flexibility Act after its quick success in the House last week.

Artificial intelligence will inevitably play a major role in hub services, improving efficiency and speed to therapy.

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.

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.

At minimum, they should engage in compliance risks; financial opportunities; key advocacy efforts; and program resources, structure, and value.