Reimbursement

Australia, Québec, and Sweden have defined processes for reimbursements by health technology assessments, but the United States has a low reliance rate.

In an ambitious effort to address the ongoing uncertainty within the 340B Program space, 6 senators released a draft discussion bill earlier this year titled the SUSTAIN Act.

By empowering pharmacy technicians to actively participate in billing and reimbursement processes, health care practices can streamline operations, mitigate billing errors, and optimize revenue generation.

The COVID-19 pandemic spring boarded the evolution of pharmacies toward establishing their position as sites of care.

Senators Ron Wyden and Mike Crapo reaffirm their support on 2 health care bills that passed the United States Senate Committee on Finance in 2023.

Laws can help eliminate common barriers to transparency but are not the only way to achieve health care transparency.

By understanding the nuances of PBM audit strategies, pharmacies can implement proactive measures to mitigate risks of recoupment, payment suspensions, and, in severe cases, network termination.

The researchers made a connection between positive outcomes for infectious disease patients, higher reimbursement class, and the presence of pharmacists in care teams.

In hospital pharmacies, roughly 2% of pharmacy spend can be overcharge.

Eli Lilly & Co. has been one of the first companies to address the off-label use of their tirzepatide drugs, Mounjaro and Zepbound, for cosmetic weight loss.

From newsworthy moments to groundbreaking research, these were the most-read reimbursement-related articles on Pharmacy Times in 2023.

The proportion of prescriptions by a 340B-affiliated physician increased from 9.4% in 2013 to 19.3% in 2020, but the prescriptions filled by 340B pharmacies increased from 18.4% to 49.9%.

Non-expansion states had an increase in prescriptions after PA removal at 27.3% and Medicaid expansion states demonstrated a 22% decrease in prescriptions.

Cheryl Larson, president and CEO of the Midwest Business Group on Health, discussed the employers’ perspectives on pharmacy benefit manager (PBM) reform efforts and how they can dovetail with the concerns of pharmacies.

Expert discusses changes health care professionals should know about drug coverage and out-of-pocket costs through the IRA

Ronna Hauser from the National Community Pharmacists Association (NCPA), discusses updates regarding reimbursement, pharmacy benefit manager (PBM) reforms, and direct and indirect remuneration (DIR) fees.

In an article by The New England Journal of Medicine, the authors discuss how drug companies could delay the approval of new oncology drugs under the IRA, delaying patient care.

RFID technology encompass a wide range of applications, including inventory management, medication authentication, patient adherence, and workflow efficiency.

Christina Barrington, PharmD, vice president of pharmacy programs at Priority Health, discusses current disruptors in the marketplace and high-cost drugs.

The hybrid pharmacy model represents a significant step forward in providing the best possible care for individuals struggling with behavioral health conditions, ultimately improving their outcomes and overall well-being.

With health systems undergoing a necessary reevaluation of how they allocate their funding into the future, initial data support the need for them to offer a hospital-at-home option for patients they serve.

Many patients face significant challenges in accessing their specialty medications, which highlights the importance of pharmacy-deployed patient navigation programs designed to help resolve nonclinical, system-related barriers to care.

Vanderbilt Specialty Pharmacy and Takeda Oncology are reaching across silos and entering an innovative partnership to improve patient care across the entire medication journey.

As pharmacists provide more health care services, opportunities arise for more sophisticated patient engagement and billing solutions that drive patient satisfaction and increased loyalty.

The committee will help the FDA address issues related to digital health technologies, including artificial intelligence, virtual reality, cyber security, and patient-generated health data.

Although education and training have historically been considered the primary factors influencing pay, the survey results challenge this notion.

Within this care model, pharmacists can serve an important role in caring for patients, whether it is identifying adverse medication interactions or pushing patients to seek additional support.

Better access to prescription drugs improves patients’ experience, adherence, and health.

The National Community Pharmacists Association said the action was sent into motion by wrongful penalties for Medicare Part D prescriptions, called pharmacy direct and indirect remuneration fees.

Current federal statutes exclude anti-obesity medications for coverage when used for anorexia, weight loss, or weight gain.