Reimbursement

The increasing prices of the drugs used to treat hookworm, roundworm (ascariasis), and whipworm (trichuriasis) is driving increased costs for patients with Medicaid or private insurance, as well as a potential decrease in the quality of care those patients receive.

The pharmaceutical supply chain, while always central to health care, will play an even more crucial role as the pandemic continues to threaten the financial viability of hospitals and health systems, large and small.

The receipt of preventive care for youth enrolled in Medicaid managed care fell significantly short of the annual goal set by the Centers for Medicare and Medicaid Services (CMS).

Third party payers have concluded that the fee-for-service system is no longer financially viable and that a new approach is necessary.

The estimate is based on a new analysis of out-of-pocket costs for influenza-related hospitalizations in 2018 that were paid by people with Medicare Advantage plans, which are Medicare plans run by private insurance companies.

Communication plays a critical role in coping strategies around health and financial challenges, according to a recent qualitative study that investigated how people cope with these challenges.

Across all of the nations studied, investigators found that the United States accounted for 58% of all prescription drug sales but just 24% of the volume.

In order to eradicate HIV, the researchers said increasing health coverage will be essential. Without that, HIV will continue to spread, and individuals will be unaware of their status.

Value-based contracts can lower costs for payers, offer pharmaceutical companies valuable feedback about their therapies, and, ultimately, improve the quality of health care.

Nonadherence is linked to poor health outcomes, including a decreased quality-of-life, disease progression, and increased hospitalizations.

The changes, finalized today, are generally effective for the 2022 plan year and will potentially lower enrollee cost sharing on some of the most expensive prescription drugs.

Katea Ravega, a partner at Quarles and Brady LLP, discussed the recent Supreme Court ruling in Rutledge v. PCMA and what it could mean for the future of states’ legislation around PBMs.

This week on Pharmacy Times, there are a number of important topics that will be covered and posted throughout the week.

There are many benefits to adopting and integrating new technological methods for hosting pharmacy organization events.

Supreme Court ruling clears the way for states to pass laws that protect pharmacies from predatory reimbursement practices by PBMs.

Supreme Court decision establishes that states do have the right to regulate pharmacy benefit managers in managed care organizations.

If current drug pricing trends continue, cost-related non-adherence to therapy will result in the premature deaths of 112,000 Medicare beneficiaries per year.

Pharmacists must demonstrate value to achieve success when implementing new services and especially when establishing an entirely new practice.

Medicaid expansion has helped to increase annual checkups among low income individuals.

The combination of COVID-19 with opioid-induced respiratory depression, especially in an elderly patient, could be deadly.

Trends and comfort levels have changed among consumers, pharmacies, and payers from 2019 to 2020 as it relates to pharmacist-provided services and value-based performance programs.

Throughout the pandemic, pharmacists have played a critical role in the COVID-19 response in several ways

For many years, employers, payers, and pharmacy benefit managers have been developing benefit designs to incentivize patients and providers to make cost-effective treatment decisions.

A kickback can arise if a pharmacy pays commissions to a 1099 independent contractor marketing representative who generates patients for the pharmacy who are covered by a federal health care program.

Financial distress and disruptions to work and social activities were significantly associated with depression and anxiety, as well as generally diminished psychological wellbeing.

In the years following the passage of the Affordable Care Act, early-stage cancer diagnosis increased while late-stage fell.

For hospital pharmacies, the COVID-19 pandemic sparked an abrupt and intensive reevaluation of nearly every aspect of their operations.

State Medicaid programs and other providers will need to learn more about the age distribution of autism among adults enrolled in Medicaid, in order to better serve them.

A recent study found that the US rural mortality penalty is wide and further expanding, which applies to the rural population overall, or all racial/ethnic groups combined, and for non-Hispanic whites, non-Hispanic blacks, and Hispanics individually.

Whether agreeing to an asset purchase or stock purchase in the sale of a pharmacy, the buyer must perform due diligence.