Reimbursement

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.

The easiest way to avoid misdiagnosis, inappropriate treatment, and potential loss of reimbursement is to prevent unsuitable testing.

The shift from fee-for-service to a value-based care payment model represents the growing understanding of the value of health care providers in improving overall patient outcomes.

Girish Dighe, PharmD, MS, explains the importance of change management within a closed-loop system. 

Safety net providers, which historically work in underserved communities, have successfully petitioned state legislatures to take action on 340B 2-tier pricing.

Counties in Medicaid expansion states saw an 11% lower rate of heroin deaths and a 10% lower rate of deaths involving synthetic opioids compared with counties in non-expansion states.