assurecare

DECEMBER 4, 2023

In the realm of Specialty Pharmacy , achieving coverage for these prescriptions by insurance after the first attempt is a rarity. Achieving coverage at a cost manageable for the average patient requires a collaborative effort from pharmacists, pharmacy technicians, nurses, patient care coordinators, and other support staff.

Insurance Coverage and Processing 81

Insurance Coverage and Processing Pharmacy Technician Specialty Pharmacies 81

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 94

Insurance Coverage and Processing Health Insurance Companies 94

Digital Pharmacist

JANUARY 26, 2023

This is helpful for saving patients money, but because Amazon Pharmacy is not processing the prescriptions through insurance, the medications will not fully show on patients’ insurance profiles. ❌ RxPass is not Available Nationwide RxPass is currently only in 42 states and Washington, D.C.

Insurance Coverage and Processing 95

Insurance Coverage and Processing Independent Pharmacies Online Pharmacies Scheduling Appointments 95

Pharmaceutical Commerce

OCTOBER 2, 2023

Kirsch discusses the complexity of the drugs and the verification process, along with Eversana’s new platform, ACTICS eAccess.

52

52

pharmaphorum

FEBRUARY 4, 2022

“We’re disappointed with the position that [CMS] has taken in its draft national coverage determination decision,” said Lilly’s chief scientific and medical officer Dan Skovronsky on the call, adding that it “essentially negates” the intention of providing patient benefit in areas of unmet medical need.

Insurance Coverage and Processing 98

Insurance Coverage and Processing Diabetes 98

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 95

Insurance Coverage and Processing Communication 95

pharmaphorum

SEPTEMBER 10, 2021

.” He blamed the poor performance on ” confusion, misinformation and controversy surrounding our data and the approval process.” Analysts think sales will be lacklustre ahead of the outcome of a review of coverage by the Center for Medicare and Medicaid Services (CMS), which isn’t expected until next year.

Labelling 96

Labelling Insurance Coverage and Processing 96

Community Pharmacy

NOVEMBER 30, 2023

Created as an insurance coverage plan for those over 65, Medicare offers four levels of benefits that cover everything from hospital insurance to prescription medicine costs. 2024 Medicare Part D Costs Updates While the cost of Part D insurance premiums is expected to decrease from an average of $56.49 in 2023 to $55.50

Insurance Coverage and Processing 52

Insurance Coverage and Processing Community Pharmacies Hospitals 52

Express Pharma

MARCH 16, 2025

On the global stage, AI and Machine Learning (ML) drove drug discovery and process optimisation, especially as large-scale pharma companies adopted AI for precision medicine. Building sophisticated laboratories, recruiting scientific talent, and collaborating with global research institutions are essential steps in this process.

Biosimilars 110

Biosimilars Insurance Coverage and Processing Pharmaceutical Companies Pharmaceutical Companies 110

Pharma in Brief

JULY 19, 2023

CADTH Time-Limited Reimbursement Recommendations Starting in the fall of 2023, CADTH, which conducts health technology assessments ( HTAs ) to inform public insurers, will introduce time-limited reimbursement recommendations for certain drug products. CADTH intends to align this process with Health Canada’s proposed agile licensing reforms.

Insurance Coverage and Processing 40

Insurance Coverage and Processing Drug Pricing 40

Putting Patients First Blog

JANUARY 4, 2024

The Abdominal Core Health Quality Collaborative (ACHQC) believes it is our obligation to listen and offer suggestions to help patients navigate the decision-making process. Choose a surgeon who communicates clearly, listens attentively, and ensures you understand the procedure, potential risks, and recovery process.

Insurance Coverage and Processing 89

Insurance Coverage and Processing Communication Hospitals 89

Express Pharma

SEPTEMBER 6, 2023

To help financially weak citizens gain access to affordable healthcare, the Pradhan Mantri Jan Arogya Yojana (PMJAY) was launched in 2018, providing about 500 million Indians with a ₹5 lakh family health insurance cover that include coverage for 1,400 medical procedures as well as critical diseases like prostate cancer.

Insurance Coverage and Processing 59

Insurance Coverage and Processing Biosimilars Generic Medicine Drug Pricing 59

Putting Patients First Blog

JANUARY 16, 2024

The NBPP is a set of rules and guidelines issued annually by CMS that outline the policies and standards for health insurance plans and issuers, primarily focusing on the Health Insurance Marketplace under the Affordable Care Act. These are the rules for the federal health insurance marketplace for the coming year.

Insurance Coverage and Processing 59

Insurance Coverage and Processing Communication 59

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 52

Drug Pricing Insurance Coverage and Processing Labelling Communication 52

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. The benefits of insurance firms are focused on main HQ offices.”. billion invested in the sector in Q1 alone. Reimbursement expected in Europe.

Insurance Coverage and Processing 85

Insurance Coverage and Processing 85

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. million Americans gain access to high-quality and affordable health coverage. of annual income for individuals and families earning more than 400% FPL.

Insurance Coverage and Processing 52

Insurance Coverage and Processing Hospitals 52

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 40

Insurance Coverage and Processing Communication Documentation Diabetes 40

pharmaphorum

OCTOBER 1, 2022

In this latest coverage, pharmaphorum speaks with Eugene Borukhovich. 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. Augmented by technology, but not replaced by technology throughout that process.”.

Insurance Coverage and Processing 98

Insurance Coverage and Processing Hospitals 98

PharmaShots

JUNE 2, 2023

Anas Batikhi: The healthcare sector, an ongoing evolving industry on its own, is simply a flowing stream of processes, revenues & valuable health outcomes. Getting this process wrong is detrimental to any revenue collections resulting from availing services to the patient.

Insurance Coverage and Processing 40

Insurance Coverage and Processing Health and Personal Care Stores Medical Records Documentation 40

pharmaphorum

AUGUST 31, 2021

In constructing an ECA, there are additional processes involved, such as planning the best study design, selecting the highest-quality clinical RWD source, defining the most appropriate inclusion/exclusion criteria, and conducting all necessary analyses to ensure the synthetic cohort is well matched to the experimental cohort. .

Insurance Coverage and Processing 89

Insurance Coverage and Processing Drug Development Documentation Labelling 89

Putting Patients First Blog

MARCH 15, 2024

ERISA is long overdue for Congressional attention, and we appreciate that the RFI starts this process. Patients need an affordable, functioning employer-sponsored insurance (ESI) system. It is additionally important to note that many of the people covered by private insurance have disabilities.

Insurance Coverage and Processing 40

Insurance Coverage and Processing 40

Pharma in Brief

FEBRUARY 2, 2022

In Canada, coverage for prescription drugs exists through an array of public and private drug plans. The Panel’s mandate did not include governance structures, financing, patient eligibility, or the interplay between public and private insurance plans. Background. a formulary); and. a formulary); and. Drug cost was not a consideration.

Insurance Coverage and Processing 59

Insurance Coverage and Processing Biosimilars Diabetes 59

Pharma Marketing Network

FEBRUARY 5, 2025

Pharmaceutical market access refers to the process of ensuring a drug is not only approved but also commercially viable, reimbursed, and accessible to patients. Rising Pricing Pressures and Cost Containment Governments and insurers are tightening cost controls to manage healthcare expenditures. Early negotiation of coverage agreements.

Insurance Coverage and Processing 52

Insurance Coverage and Processing Drug Pricing Pharmaceutical Companies Pharmaceutical Companies 52

pharmaphorum

NOVEMBER 1, 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. The patient’s journey is typically long and complicated ?

HIPAA 98

HIPAA Insurance Coverage and Processing Specialty Pharmacies Communication 98

pharmaphorum

JANUARY 28, 2021

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.

Biosimilars 119

Biosimilars Insurance Coverage and Processing Drug Pricing Diabetes 119

Putting Patients First Blog

OCTOBER 15, 2023

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. Finally, the timing of the scoring process can be frustrating when working to advance good policy. Best Price).

Insurance Coverage and Processing 40

Insurance Coverage and Processing 40

Putting Patients First Blog

OCTOBER 31, 2024

652 and HR 2630 ) would ensure that employer health plans offer a medically reasonable step therapy exceptions process, intended to help patients more quickly access effective treatments. Introduced by Senator Lisa Murkowski (R-AK) and Representative Brad Wenstrup (R-OH), the bipartisan Safe Step Act ( S.652

Insurance Coverage and Processing 52

Insurance Coverage and Processing Hospitals Drug Development 52

Putting Patients First Blog

FEBRUARY 1, 2024

System-Wide Public Transparency One likely policy to be included in a health care package is increased transparency into health care costs and coverage, which is a priority of the patient community. The House passed H.R. 5378 More Transparency, Lower Costs Act in December 2023.

Insurance Coverage and Processing 52

Insurance Coverage and Processing Packaging Hospitals 52

Pharmaceutical Technology

NOVEMBER 30, 2022

In the US, most private health insurers have been slow to cover the cost of anti-obesity therapeutics. Medicare Part A, Part B, and Part D do not generally cover approved weight loss medications like Saxenda, but Medicare Advantage plans may allow for expanded coverage, as per the Medicare.org site.

Insurance Coverage and Processing 105

Insurance Coverage and Processing Diabetes Labelling Communication 105

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 52

Drug Pricing Insurance Coverage and Processing Labelling HIPAA 52

Pharmaceutical Technology

NOVEMBER 30, 2022

In the US, most private health insurers have been slow to cover the cost of anti-obesity therapeutics. Medicare Part A, Part B, and Part D do not generally cover approved weight loss medications like Saxenda, but Medicare Advantage plans may allow for expanded coverage, as per the Medicare.org site.

Insurance Coverage and Processing 98

Insurance Coverage and Processing Diabetes Labelling Communication 98

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 105

Insurance Coverage and Processing Immunity Immunization Dosage 105

Putting Patients First Blog

JUNE 5, 2023

This is not a venue that patients and their advocates have access to, as health insurance plans are the primary users of the portal. CMS must ensure stakeholders have ample opportunity to provide input throughout the implementation and adjustment process. A simple 30-day comment period process will likely not be sufficient.

Insurance Coverage and Processing 40

Insurance Coverage and Processing Communication 40

Proxsys Rx

SEPTEMBER 26, 2023

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. Our pharmacists were only too happy to help.

Insurance Coverage and Processing 52

Insurance Coverage and Processing Hospitals Prescription Filling Specialty Pharmacies 52

pharmaphorum

OCTOBER 7, 2021

“In some countries, such as Germany, France, and the United Kingdom, certain Digital Therapeutics are readily reimbursed and marketed. .

Insurance Coverage and Processing 52

Insurance Coverage and Processing Communication Diabetes 52

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 40

Insurance Coverage and Processing Biosimilars Communication Department of Veterans Affairs 40

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 40

Insurance Coverage and Processing Communication Hospitals 40