pharmaphorum

FEBRUARY 4, 2022

Lilly is a little vague on when it will now file donanemab with the FDA – suggesting on its fourth quarter 2021 results call that it may do so later this year – but reiterated that it has little hope of the drug being used ahead of the readout of TRAILBLAZER-ALZ 2 in mid-2023.

Insurance Coverage and Processing

Putting Patients First Blog

JANUARY 9, 2025

Medicaid is a critical lifeline for patients and provides insurance for nearly 80 million people across every state in the country. Prevent health insurance premium increases. Since the enhanced APTCs were first enacted in 2021, they have helped 9.4 million Americans gain access to high-quality and affordable health coverage.

Insurance Coverage and Processing

Putting Patients First Blog

SEPTEMBER 3, 2024

The NHC appreciates CMS’ efforts to gather patient-centered data as part of this ICR and its commitment to making the process more relevant for patients and patient organizations. While we acknowledge these improvements, it is important to note that some aspects of the data collection process may remain challenging.

Drug Pricing

pharmaphorum

OCTOBER 1, 2022

In this latest coverage, pharmaphorum speaks with Eugene Borukhovich. Borukhovich is hesitant to compare this year’s conference with the 2021 event. “I If we look at insurers, during the kind of peak of the pandemic, insurers were not paying out, so, there was in theory lots of cash saved up for further investments.

Insurance Coverage and Processing

pharmaphorum

APRIL 29, 2021

Officially launched in 2016, Kaia’s technology can now be accessed by 60 million patients worldwide and it claims to be the biggest player in digital MSK in terms of coverage. “Last year saw record investment in digital health and according to a Rock Health report this continued into 2021, with $6.7

Insurance Coverage and Processing

Putting Patients First Blog

JANUARY 10, 2024

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.

Insurance Coverage and Processing

Pharmaceutical Technology

NOVEMBER 30, 2022

The company’s weight loss drug Saxenda (liraglutide) won an approval for chronic weight management in December 2014, and Wegovy (semaglude) got the same tag in 2021. To overcome manufacturing issues, in December 2021, Novo Nordisk announced its plans to build three new manufacturing facilities. compared to a 5.1% Free Report.

Insurance Coverage and Processing

pharmaphorum

AUGUST 31, 2021

Still, in 2021, we have seen the industry evolve and develop strategies on how to establish a viable ECA. We have seen some select examples of this across the industry, but in order to get to state where there is more widespread application of them, a more systematic approach to ECAs must be embedded into the overall development process.

Insurance Coverage and Processing

Pharmaceutical Technology

NOVEMBER 30, 2022

The company’s weight loss drug Saxenda (liraglutide) won an approval for chronic weight management in December 2014, and Wegovy (semaglude) got the same tag in 2021. To overcome manufacturing issues, in December 2021, Novo Nordisk announced its plans to build three new manufacturing facilities. compared to a 5.1% Free Report.

Insurance Coverage and Processing

pharmaphorum

OCTOBER 7, 2021

Milan, Italy | October 5, 2021 – Originally published in January 2021 for Italian audiences, the international, updated version of “DTx: An Opportunity for Italy and Beyond” is now available in English.

Insurance Coverage and Processing

The Thyroid Pharmacist

AUGUST 4, 2023

4] One of the key things to note is that this gene variation also prevents people from properly methylating, which is one of the body’s key detox processes that helps them get rid of toxins. However, some may be concerned with this genetic information getting reported on insurance or to employers.

Insurance Coverage and Processing

Putting Patients First Blog

OCTOBER 15, 2023

In 2021, the NHC updated its Policy Recommendations for Reducing Health Care Costs. As the primary insurer for millions of Americans and as the programs that drive decisions throughout the health ecosystem, these federal programs can be a critical driver of innovations. The specific comments below are informed by those recommendations.

Insurance Coverage and Processing

Putting Patients First Blog

JULY 2, 2024

We believe that patient-centric engagement is essential to ensure that the negotiation process leads to outcomes that genuinely benefit patients. Patient Engagement The NHC recognizes and commends CMS’ willingness to improve the listening sessions and the data submission processes. Improving the Data Collection (ICR) Process.

Drug Pricing

Putting Patients First Blog

JANUARY 27, 2025

Coverage of Anti-Obesity Medications (AOMs) The NHC applauds CMS for aligning with the medical community and proposing to recognize obesity as a chronic disease and allow Medicare Part D coverage for AOMs. Below, we provide detailed comments and recommendations on key provisions of the proposed rule.

Insurance Coverage and Processing

Putting Patients First Blog

MARCH 4, 2024

Under the new Manufacturer Discount Program, manufacturers will be required to provide discounts on applicable drugs during the initial coverage phase and catastrophic phase of the defined standard Part D drug benefit.

Insurance Coverage and Processing

Putting Patients First Blog

MARCH 4, 2024

Ensure Comprehensive Transparency in Formulary Management: Provide clear, comprehensive guidelines to Part D plans to ensure transparency in plan coverage, tiering, and utilization management (UM) policies, offering safeguards against practices that could restrict access to necessary treatments.

Insurance Coverage and Processing

PharmaShots

FEBRUARY 9, 2023

It includes various tests such as, visual acuity test (for clarity), visual field test (for peripheral vision), tonometry test (pressure in eyes), pupil response test (way of lights enter into eyes) Optical Coherence Tomography: A non-invasive retina imaging test that uses light waves to take high resolution cross-section pictures of retina.

Insurance Coverage and Processing

Putting Patients First Blog

MAY 29, 2024

1 This trend underscores the importance of informed decision-making for those with chronic diseases and disabilities, who face crucial choices regarding their health care coverage – whether selecting between traditional Medicare and MA, choosing among MA plans, or navigating their selected plan to access necessary care. As of 2023, 30.8

Insurance Coverage and Processing

Putting Patients First Blog

JULY 15, 2024

Too often the formal notice and comment process does not reach these marginalized communities and federal agencies must actively work to seek their input in non-traditional ways. This process respects their autonomy by involving them in decision-making to the extent that they are able.

Health and Personal Care Stores

Big Molecule Watch

AUGUST 25, 2023

Congress left Medicare drug pricing to the drug manufacturers, pharmacies, and insurance plan sponsors to determine, and expressly prohibited the government from “interfering” in those private price negotiations under the so-called “Non-Interference Clause” of the Medicare Modernization Act of 2003.

Drug Pricing

PharmaShots

JUNE 28, 2023

In 2020 and 2021, this decrease was driven by lower net selling price, unit demand, and unfavorable changes in inventory, partially offset by favorable changes to estimated sales deductions and inventory.

Biosimilars

STAT

AUGUST 17, 2023

billion recorded in 2021. Bancel is in the process of donating a vast majority of his income to charities. That amount of money could buy Costco memberships for more than 66 million people, and it’s equivalent to the entire economic output of Sierra Leone. That CEO haul was down 11% from the $4.5

Insurance Coverage and Processing

Express Pharma

JULY 29, 2024

Shield is also the first blood test for CRC screening that meets the requirements for Medicare coverage. Commercial insurance coverage for patients eligible for CRC screening will continue to expand following anticipated future guideline inclusion by the American Cancer Society and the U.S. Accessed December 17, 2021.

Insurance Coverage and Processing

The Happy PharmD

SEPTEMBER 15, 2024

Since 2021, pharmacy-related organizations have been addressing stress and burnout in the profession. Or perhaps it’s the constant back-and-forth with insurance companies over coverage? A survey conducted in 2021 highlighted this concern, indicating that workforce issues are a common challenge. in 2019 to 2.59.

Insurance Coverage and Processing

The Happy PharmD

MARCH 13, 2025

UHGs journey started in 1974 as Charter Med Incorporated, just another claims-processing operation. The Wall Street Journal reported that UHG was one of the worst offenders when it came to manipulating Medicare Advantage claimsraking in over $8 billion in potentially fraudulent payments in 2021 alone. Thats not a rounding error.

Insurance Coverage and Processing

PharmaShots

MAY 24, 2023

In 2022, Vertex Pharma’s net product revenue spiked by 18%, vs. 2021, mainly due to influx of Trikafta in multiple countries internationally and the growing performance of Trikafta in the U.S. Limited Coverage: Insurance coverage and reimbursement policies may vary, leading to potential barriers for some patients in accessing Trikafta.

Insurance Coverage and Processing

Pharmaceutical Technology

MAY 26, 2023

Mackey says that people may seek medications due to issues with health insurance policies, variable coverage for certain conditions, lack of access, and more. 2021 was a year of continued innovation and change in the Biopharmaceutical industry. The FDA also caught the latter website selling unapproved and misbranded drugs.

Online Pharmacies

The Thyroid Pharmacist

JULY 28, 2023

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.)

Insurance Coverage and Processing

Putting Patients First Blog

SEPTEMBER 9, 2024

16 We encourage CMS to continue refining these data collection processes to ensure they capture meaningful and actionable information. We believe this process is crucial for adapting the payment system to evolving clinical practices and emerging medical technologies.

Insurance Coverage and Processing

Putting Patients First Blog

SEPTEMBER 9, 2024

As these technologies become increasingly integral to patient care, it is essential for CMS to develop clear and consistent guidelines for the payment and coverage of AI-enabled services. Providing clear guidance, technical assistance, and streamlined processes can help facilitate the adoption of this innovative care model.

Insurance Coverage and Processing

Putting Patients First Blog

JANUARY 16, 2025

The NHCs letter to Congress outlined patient priorities in several areas: Medicaid Coverage Nearly 80 million Americans receive benefits from Medicaid, which serves as an essential lifeline for individuals who otherwise would not receive health care.

Insurance Coverage and Processing

Proxsys Rx

AUGUST 16, 2023

After all, as reported in a March, 2021 Fact Sheet published by the American Hospital Association , the total value of the 340B program amounts to just 5% of the U.S. Irrespective of insurance status, no patient pays retail drug prices. million people will become uninsured after losing Medicaid coverage. drug market.

Insurance Coverage and Processing