Estimated cost of potential “frozen formulary” legislation
February 02, 2021
“Frozen formulary” legislation refers to regulations proposed by state legislators that would prohibit a pharmacy benefit manager (PBM) or health...
Prescription drugs are covered either through a health plan’s pharmacy or medical benefit. This designation largely depends on whether the drug is self-administered or given in a clinical setting. While the reimbursement process through the pharmacy benefit is straightforward and well-managed by PBMs, reimbursement through the medical benefit is much more imprecise. Due to variability in medical claims submission processes and other reimbursement practices, it is difficult for payers to accurately evaluate medication costs and patient utilization in the medical benefit.
To ease this confusion, payers and PBMs are exploring ways to apply the tools successfully used in the pharmacy benefit to the medical benefit. Streamlining coverage would allow for the implementation of treatment pathways and more comprehensive utilization management interventions for targeted conditions. In the long-term, this will exert downward pressure on drug prices and will provide more robust information on specialty drug usage and outcomes.
Estimated cost of potential “frozen formulary” legislation
February 02, 2021
“Frozen formulary” legislation refers to regulations proposed by state legislators that would prohibit a pharmacy benefit manager (PBM) or health...
January 25, 2021
A new report, “Pharmacy Services Administrative Organizations (PSAOs) and their Little-Known Connection to Independent Pharmacies,” sheds light on the role...
January 07, 2021
A new white paper by the Pharmacy Benefit Management Institute (PBMI) outlines ways that some drug manufacturers undermine formulary and...
PCMA Applauds Congressional Action on Legislation to Boost use of Biosimilars
April 15, 2021
(Washington, D.C.) — Pharmaceutical Care Management Association President and CEO JC Scott issued the following statement on legislation passed by Congress to...
PCMA Welcomes Additions to Federal Affairs, Human Resources, and Industry Relations Teams
April 12, 2021
(Washington, D.C.) — The Pharmaceutical Care Management Association (PCMA) is announcing new personnel additions to its Federal Affairs, Human Resources,...
Pharmacy Data Sets the Record Straight: Number of Independent Pharmacies in U.S. Increasing
March 29, 2021
(Washington, D.C.) — The number of independent pharmacies in the United States increased in 2020, according to a new analysis...
May 30, 2016
Magellan Rx — Magellan Rx Management is pleased to present the sixth edition of our Medical Pharmacy Trend Report,™ the...
May 04, 2016
Healthcare: The Journal of Delivery Science and Innovation — A new study by the CVS Health Research Institute found that...
Immunoglobulin Utilization Management
April 30, 2016
Magellan Rx — Purpose: To measure the impact of a comprehensive utilization management and dose optimization program on overall immunoglobulin...
Oncology Care: Controlling Costs, Improving Value and Enhancing Care
January 30, 2016
CVS Health — In recent years, unprecedented strides in oncology care have been made – with many treatment options now...