Beckers Hospital Review

AUGUST 1, 2025

Mr. Angelone, co-founder and chief commercial officer of MacroHealth, has over 25 years of experience in the health insurance and technology industries. Mr. Angelone has also ensured compliance with key regulations like the No Surprises Act and Transparency in Coverage rules, promoting greater transparency in healthcare pricing.

Insurance Coverage and Processing

Pharmaceutical Technology

AUGUST 7, 2025

This trend is primarily driven by the success of Covid vaccines such as Moderna’s Spikevax and BioNTech and Pfizer’s Comirnaty, which generated sales of $18.4bn and $42.4bn in 2022, respectively, according to a GlobalData report. mRNA vaccine coverage on Pharmaceutical Technology (or Clinical Trials Arena) is supported by Trilink.

Insurance Coverage and Processing

Integra X Files

MAY 22, 2023

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.

Insurance Coverage and Processing

pharmaphorum

JUNE 27, 2022

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. .

Insurance Coverage and Processing

pharmaphorum

OCTOBER 1, 2022

With Frontiers Health 2022 mere weeks away, we continue to interview members of the steering committee, gaining insight into what to expect from Milan. In this latest coverage, pharmaphorum speaks with Eugene Borukhovich. But he does admit a considerable excitement about Frontiers Health 2022. “I It’s only September.

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

Pharma in Brief

FEBRUARY 2, 2022

The feedback will inform a stakeholder session in spring 2022 and the Panel’s final report. In Canada, coverage for prescription drugs exists through an array of public and private drug plans. The Panel is seeking input from stakeholders on or before February 25, 2022 via an online questionnaire. Background. a formulary); and.

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. In response to their success, Congress extended these enhanced tax credits in 2022 through the end of 2025. Pass the bipartisan Safe Step Act.

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

pharmaphorum

NOVEMBER 1, 2022

billion in a Series D funding round in April 2022. Open protocol, simply put, is a digital language that facilitates electronic transactions among prescribers, pharmacies, patient support vendors, data aggregators, insurers, and other stakeholders in the specialty pharmaceutical patient journey. Visa’s attempted $5.3

HIPAA

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

Pharmaceutical Technology

NOVEMBER 30, 2022

billion in 2022 alone to expand capacity. In the US, most private health insurers have been slow to cover the cost of anti-obesity therapeutics. Insurance may not cover these without showing clinical event reductions, and I am concerned that it may take five to 10 years to show this for just obesity,” Lavie added.

Insurance Coverage and Processing

Pharmaceutical Technology

NOVEMBER 30, 2022

billion in 2022 alone to expand capacity. In the US, most private health insurers have been slow to cover the cost of anti-obesity therapeutics. Insurance may not cover these without showing clinical event reductions, and I am concerned that it may take five to 10 years to show this for just obesity,” Lavie added.

Insurance Coverage and Processing

Proxsys Rx

SEPTEMBER 26, 2023

In 2022 alone, TMH’s 710+ physicians, and its medical staff, saw 31,190 inpatient admissions. Even with her insurance coverage, the co-pay was beyond her means. The gentleman in question had no health insurance coverage at all, and the cash price for his prescription was far beyond his means to pay.

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

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

Proxsys Rx

APRIL 4, 2024

We published that post in September, 2022. In some states, you can combine specialty and retail, but the retail operation is subject to the heavy policy and process requirements of specialty accreditation — which is an onerous burden for a retail pharmacy. Fortunately, those steps tend to be the least burdensome in the process.

Specialty Pharmacies

Proxsys Rx

AUGUST 22, 2023

We published that post in September, 2022. In some states, you can combine specialty and retail, but the retail operation is subject to the heavy policy and process requirements of specialty accreditation — which is an onerous burden for a retail pharmacy. Fortunately, those steps tend to be the least burdensome in the process.

Specialty Pharmacies

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

Proxsys Rx

NOVEMBER 8, 2023

In 2022 alone, TMH’s 710+ physicians, and its medical staff, saw 31,190 inpatient admissions. Even with her insurance coverage, the co-pay was beyond her means. The gentleman in question had no health insurance coverage at all, and the cash price for his prescription was far beyond his means to pay.

Insurance Coverage and Processing

Putting Patients First Blog

MARCH 4, 2024

Regarding the CMS-HCC risk adjustment model and the adjustments to the Part D risk adjustment model, in line with the Inflation Reduction Act (IRA) of 2022, the NHC appreciates the intent to more accurately capture the health care needs of beneficiaries, especially those with chronic conditions.

Insurance Coverage and Processing

Proxsys Rx

DECEMBER 22, 2023

We published that post in September, 2022. In some states, you can combine specialty and retail, but the retail operation is subject to the heavy policy and process requirements of specialty accreditation — which is an onerous burden for a retail pharmacy. Fortunately, those steps tend to be the least burdensome in the process.

Specialty Pharmacies

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

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

The Thyroid Pharmacist

JUNE 30, 2023

Luckily, even without insurance coverage, this medication is available in generic form and is very affordable, usually costing between $15 to $40 per month. It’s a process and a journey, but it’s definitely worth it. link] Accessed January 25, 2022. [9] You fit the pieces together to complete the puzzle. 2019 Jul 31.

Compounding

PharmaShots

JUNE 28, 2023

The decrease in Enbrel sales for 2022 was primarily driven by unfavorable changes to estimated sales deductions, lower volume, and lower net selling prices. Although, the sales of Enbrel have been decreasing continuously over the past 5 years, it has been holding its spot in the top-performing drugs.

Biosimilars

STAT

AUGUST 17, 2023

The health care industry didn’t just provide a safe haven for jittery stock investors in 2022, a year defined by inflation and higher interest rates. By almost every measure, 2022 was a bad year for the stock market. Bancel is in the process of donating a vast majority of his income to charities. billion recorded in 2021.

Insurance Coverage and Processing

Express Pharma

JANUARY 12, 2024

In the Union Budget 2022-23, the Ministry of Health and Family Welfare received an allocation of about Rs 86,200 crore, representing a 16.5 The time for commencing manufacturing or production was extended to 31 March 2024 by the Finance Act, 2022. 18 of 2022 (Question No. percent increase compared with the previous year.

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. Shield is also the first blood test for CRC screening that meets the requirements for Medicare coverage. References: The Shield test meets performance requirements for Medicare coverage under NCD 210.3. Doubeni, C, et al.

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 Justice Department fought UHGs acquisition of Change Healthcare in 2022, warning of antitrust concerns. in 2020 to 22% in 2022. This isnt just an IT problem. That concern wasnt misplaced. Thats double. UHG isnt slowing down.

Insurance Coverage and Processing

Community Pharmacy

NOVEMBER 15, 2022

If this applies to you, then you can begin your application process here to get the process started. Medicare Part D has four phases of coverage that users need to be aware of before and during enrollment in the program. In 2022, the annual deductible limit was set at $480. In 2022, the initial coverage limit was $4,430.

Insurance Coverage and Processing

The Happy PharmD

SEPTEMBER 15, 2024

Based on the data, the average distress level among pharmacists has decreased compared to previous reports spanning from 2019 to 2022. Or perhaps it’s the constant back-and-forth with insurance companies over coverage? It has declined from 3.25 in 2019 to 2.59. Share your thoughts down below!

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

In October 2022, the FDA reported an Adderall shortage , leaving many without access to the drug. Mackey says that people may seek medications due to issues with health insurance policies, variable coverage for certain conditions, lack of access, and more.

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

NOVEMBER 12, 2024

General Support for CMS Proposals The NHC commends CMS for its ongoing commitment to advancing health equity, improving access to care, ensuring program integrity, and maintaining affordability through Marketplace coverage. Copay Assistance and Drug Coverage in Large Group Plans Accumulator Adjustment Programs and Cost Sharing.

Insurance Coverage and Processing