Reimbursement

Two shingles vaccines are licensed and recommended in the United States.

The amicus brief from the Academy of Managed Care Pharmacy argues that a ruling in favor of Rutledge would drive up health care costs and hinder patients’ ability to access affordable medications.

One of the primary means of performing billable services is through ‘incident-to’ billing.

Pharmacies can generate an average of $8800 per month from services such as consultations, educational classes, and immunizations.

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.

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.

Specialty pharmacies can provide seamless support across specialty mail and retail channels.

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.

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.

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.

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.