Reimbursement

Health systems individually have struggled to demonstrate improvements to total cost of care because, without data about patients they do not serve, they cannot define a comparison group.

Scripta surveyed 372 respondents between 18 and 60 years of age about American attitudes and behaviors around prescription drug pricing.

Many pharmacies and safety-net providers were preparing for the long-anticipated transition from Medicaid managed care to fee-for-service (FFS)—known as the carve-out—that was set to take effect on May 1, 2021.

Recent estimates suggest that 40% of near-poor individuals on Medicare spend at least one-fifth of their income on health care expenses, according to the study.

The researchers analyzed millions of pharmacy transactions by more than 600,000 people in the United States from 2017 to 2019 in order to get a better sense of how vouchers and other point-of-sale co-payment offsets are used.

The Medicare payment amount for administering the COVID-19 vaccine is increasing, according to a statement from the Centers for Medicare and Medicaid Services.

The increasing prices of the drugs used to treat hookworm, roundworm (ascariasis), and whipworm (trichuriasis) is driving increased costs for patients with Medicaid or private insurance, as well as a potential decrease in the quality of care those patients receive.

The pharmaceutical supply chain, while always central to health care, will play an even more crucial role as the pandemic continues to threaten the financial viability of hospitals and health systems, large and small.

The receipt of preventive care for youth enrolled in Medicaid managed care fell significantly short of the annual goal set by the Centers for Medicare and Medicaid Services (CMS).

Third party payers have concluded that the fee-for-service system is no longer financially viable and that a new approach is necessary.

The estimate is based on a new analysis of out-of-pocket costs for influenza-related hospitalizations in 2018 that were paid by people with Medicare Advantage plans, which are Medicare plans run by private insurance companies.

Communication plays a critical role in coping strategies around health and financial challenges, according to a recent qualitative study that investigated how people cope with these challenges.

Across all of the nations studied, investigators found that the United States accounted for 58% of all prescription drug sales but just 24% of the volume.

In order to eradicate HIV, the researchers said increasing health coverage will be essential. Without that, HIV will continue to spread, and individuals will be unaware of their status.

Value-based contracts can lower costs for payers, offer pharmaceutical companies valuable feedback about their therapies, and, ultimately, improve the quality of health care.

Nonadherence is linked to poor health outcomes, including a decreased quality-of-life, disease progression, and increased hospitalizations.

The changes, finalized today, are generally effective for the 2022 plan year and will potentially lower enrollee cost sharing on some of the most expensive prescription drugs.

Katea Ravega, a partner at Quarles and Brady LLP, discussed the recent Supreme Court ruling in Rutledge v. PCMA and what it could mean for the future of states’ legislation around PBMs.

This week on Pharmacy Times, there are a number of important topics that will be covered and posted throughout the week.

There are many benefits to adopting and integrating new technological methods for hosting pharmacy organization events.

Supreme Court ruling clears the way for states to pass laws that protect pharmacies from predatory reimbursement practices by PBMs.

Supreme Court decision establishes that states do have the right to regulate pharmacy benefit managers in managed care organizations.

If current drug pricing trends continue, cost-related non-adherence to therapy will result in the premature deaths of 112,000 Medicare beneficiaries per year.

Pharmacists must demonstrate value to achieve success when implementing new services and especially when establishing an entirely new practice.

Medicaid expansion has helped to increase annual checkups among low income individuals.