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Prior Authorization: Two Words We Love to Hate

Integra X Files

Prior authorization has been popular with the insurance industry because it works. This is known as the sentinel effect, and in the initial stages, providers accommodated the process without much complaint. The health insurance industry didn’t have many other tools to suppress demand, so it went with the sentinel effect by default.

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How the US’s pending PIE Act will improve patient access to medication

pharmaphorum

Jennifer Mathieu, director of government relations at the Academy of Managed Care Pharmacy (AMCP), tells us why the organisation backed the pre-approval information exchange (PIE) Act of 2022 and how the legislation will empower companies to share information with healthcare payers and plans during the FDA approval process. .

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NHC’s comments in response to the 2025 Notice of Benefit and Payment Parameters (NBPP)

Putting Patients First Blog

Making available more specific information about total costs and coverage will ensure that all consumers have comprehensive information to help them make smart health care decisions. These resources should aim to clarify insurance terms and concepts, aiding consumers in navigating the complexities of selecting a health plan.

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The US biosimilar market: Predictions for 2021

pharmaphorum

Pharmacists have more insight into a patient’s insurance coverage than most providers, so this change could create a lot of value for patients throughout the country. It will be the first time pharmacists can help patients access a more cost-effective biosimilar since the launch of the category five years ago. About the author.

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Budget expectation: Bring GST rate on APIs at par with the formulations

Express Pharma

Due to the multiplicity of regulatory processes and multiple regulators, undertaking operations become complex and time consuming. IRDAI has included the health insurance coverage for 12 such modern treatment methods under Chapter V of the Guidelines on “Standardisation of exclusions in health insurance contracts”.

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Finding Your Root Cause: Key Lab Tests

The Thyroid Pharmacist

I’ll specify which tests are usually covered on insurance if you have a willing practitioner that can bill insurance, which tests can be self-ordered and then submitted to insurance, and which ones are usually an out-of-pocket expense that you may need to save for. You can use Health Savings Accounts for most.)

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The “Medical Bypass”: new drugs to strike obesity

Pharmaceutical Technology

A 2017–2018 National Health and Nutrition Examination Survey (NHANES), showed that 30.7% In the US, most private health insurers have been slow to cover the cost of anti-obesity therapeutics. Furthermore, an increase in a sedentary lifestyle, partly brought on by the Covid-19 pandemic, saw a further rise in the obese population.