January 07, 2021
A new white paper by the Pharmacy Benefit Management Institute (PBMI) outlines ways that some drug manufacturers undermine formulary and...
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.
January 07, 2021
A new white paper by the Pharmacy Benefit Management Institute (PBMI) outlines ways that some drug manufacturers undermine formulary and...
Impact of Medicare Part D Drug Manufacturer Rebates at the Point-of-Sale
November 18, 2020
A new report by Milliman shows that over the 10-year period 2022-2031, if all manufacturer rebates were reflected at the...
Negative Economic Impact of Restricting Drug Rebates in Medicare Part: Matrix Global Advisors
September 02, 2020
“Negative Economic Impact of Restricting Rebates in Medicare Part D,” by Alex Brill of Matrix Global Advisors (MGA), examines recent...
PCMA Statement on Senate Finance Committee Insulin Report
January 14, 2021
(Washington, D.C.) – The Pharmaceutical Care Management Association (PCMA) released the following statement on the Senate Finance Committee’s report on...
PCMA Federal Policy Priorities: 21 Policies to Reduce Prescription Drug Costs in 2021
January 14, 2021
(Washington, D.C.) — The Pharmaceutical Care Management Association (PCMA) today issued 21 policy solutions supported by America’s pharmacy benefit managers (PBMs) aimed at reducing prescription...
PCMA Files Lawsuit Challenging Rebate Rule
January 12, 2021
(Washington, D.C.) — The Pharmaceutical Care Management Association (PCMA) today filed a lawsuit challenging the Trump Administration’s rebate rule. PCMA’s...
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...