Utilization Management

Utilization Management state laws define parameters that health plans must follow when developing utilization management processes, including drug categories for applicability, criteria for determinations, appeals process, and clear transparency of the process to providers and patients.

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2026 RI S 2109 Comment Letter

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2026 MA DOI Proposed Amendments Comment Letter

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2026 KS HB 2703 Comment Letter

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Increased Costs Associated With Proposed State Legislation Impacting PBM Tools (Report, 2023)

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AMA Prior Authorization Survey, 2021.

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Effective Gold Carding Programs are Based on Evidence and Value for Patients (AHIP Prior Authorization Survey Results—July 2022).

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American Heart Association, Circulation: Cardiovascular Quality and Outcomes, “Streamlining and Reimagining Prior Authorization Under Value-Based Contracts: A Call to Action From the Value in Healthcare Initiative’s Prior Authorization Learning Collaboration,” Mitchell A. Psotka, MD et al.,

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Utilization Management Benefits Patients (Talking Points, 2023)

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What is Utilization Management in a Pharmacy Benefit (Explainer, 2023)

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Oppose One-Size-Fits-All Prior Authorization “Gold Carding” Programs (Talking Points, 2023)

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What Is Gold Carding? (Explainer, 2023)

New PCMA advocacy material explaining the issue of gold carding.

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