Managed Care News

Medication Therapy Management

September 03, 2020

A plus for both patients and pharmacists

Pharmacy Groups Urge CMS to Reimburse for Medical at Home Services

July 07, 2020

A group of pharmacies and pharmacy organizations urged the Centers for Medicare & Medicaid Services to formally recognize and promote medical at home pharmacy services for long-term care.

Poll Identifies Concerns About Rising Costs of Drugs, Health Care Amid Pandemic

June 23, 2020

A new poll by Gallup and West Health found that a majority of Americans have expressed numerous health care system-related concerns, including rising costs of drugs, insurance premiums, and health care in response to COVID-19.

Generics and Biosimilars Facing Formulary Difficulties

September 11, 2019

New changes are making it more difficult for generics and biosimilars to compete on formularies.

How to Raise Diabetes Drug Adherence

June 16, 2017

New study shows that a Universal Medication Schedule could help diabetes patients.

Adding biosimilars to formularies: The pharmacist's role

August 10, 2016

Pharmacists on P&T committees are going to face issues that range from biosimilar naming systems to challenges in dispensing and costs.

Coming regs expand pharmacist role in LTC

August 10, 2016

“Basically, everything we know will be gutted over the next three years.”

Patients, payers, and manufacturers’ drug coupons

June 10, 2016

According to PBMs, those drug coupons are something else.

Pharmacists seek fairness in generics reimbursement

May 31, 2016

PBMs have dodged state-mandated requirements for transparency in generics drug pricing, so many states are rewriting their laws.

Generic treatment for chronic myeloid leukemia could save millions

May 03, 2016

Five years of imatinib treatment for CML = >$100,000 saved per patient.

Cost vs. value: Healthcare shifts its focus

July 10, 2015

Value-based care is transforming the world of healthcare. Simple cost management must give way to utilization management, and alignment of stakeholder services is inevitable.

The consequences of high out-of-pocket medication costs

April 10, 2015

Cost of treatment often forces aging patients on limited incomes to choose between paying for medications or for food and rent.

The transformation of pharmacy in a rapidly changing retail environment

April 10, 2015

Key trends point to a collaboration between pharmacies and healthcare stakeholders that will shape better delivery of patient education, adherence support, and financial assistance.

Provider status: Important to pharmacists, critical to patients

March 10, 2015

Validation through inclusion in Medicare Part B could lead to recognition of pharmacists as healthcare providers across the board.

Independent pharmacies sue PBM Catamaran, alleging illegal conduct

February 13, 2015

A group of 55 pharmacies located mainly in Pennsylvania has turned to the courts to resolve reimbursement differences with Catamaran.

PBMs, insurers strike deals for Hep C drugs

February 11, 2015

Discounts and rebates negotiated by some third-party payers are ensuring the place of hepatitis C drugs in their formularies.

Specialty drugs and the role of managed care pharmacy

July 10, 2014

As specialty pharmaceuticals consume more of the healthcare dollar, the role of managed care pharmacy will be critical.

BCBS program drastically reduces painkiller scripts

April 24, 2014

An 18-month statewide program to decrease painkiller prescriptions and lower addiction risks resulted in 6.6 million fewer doses dispensed, Blue Cross Blue Shield of Massachusetts recently announced.

PBMs to limit availability of branded drugs on formularies

January 20, 2014

Express Scripts and CVS Caremark are expected to expand their list of non-covered drugs for the 2015 plan year, leading to challenging pricing negotiations between branded pharmaceutical companies and PBMs.

ACOs receive mixed grades in self-assessment study

January 17, 2014

Some people credit ACOs with lowering healthcare costs and improving quality. But a new study reveals that while ACOs are performing well in some areas, they fall woefully short in many others.