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managed care

PBMs Implement Sweeping Reimbursement Cuts and Ramp Up Audits

Pharmacy benefit managers have responded to a new CMS rule requiring them to account for all ...

DECEMBER 26, 2023

Formulary Decisions for Ultra–High-Cost Therapies Likely to Shift to Payors

More than three-fourths of respondents to the ASHP 12th annual Pharmacy Forecast believe that formulary and policy ...

DECEMBER 12, 2023

Non-White Part D Beneficiaries and Low-Income Subsidy Recipients to Be Most Affected by IRA Spending Cap

Non-white Medicare Part D beneficiaries are among those who will be most affected by a $2,000 out-of-pocket ...

OCTOBER 19, 2023

4 Case Studies Highlight AI’s Role in Improving Pharmacy Benefit Performance

Artificial intelligence and machine learning can flag claims errors, prevent fraud, waste and abuse and streamline ...

OCTOBER 18, 2023

Novel Technologies to Improve Management of Opioid Use Disorders

Alexandria, Va.—With technology transforming industries in the United States, it’s time to apply ...

FEBRUARY 28, 2020

CVS Health Focuses on 'Hyperinflation' in Drug Cost Containment Effort

CVS Health removed five drugs from its formulary in April 2019 and replaced them with lower-cost alternatives as ...

AUGUST 28, 2019

A Dip in Statin Therapy Compliance Stirs Debate

Although the prevalence of heart disease–related conditions and diabetes have increased, statin use remains ...

AUGUST 21, 2019

Magellan Program Boosts Uptake of Biosimilar Infliximab

When a comprehensive management approach—switching all patients to a biosimilar agent—was used, health ...

APRIL 23, 2019

Gene Therapies Expected to Disrupt Drug Payment System

The high price tags and front-loaded cost burden of novel gene therapies are leading payors to experiment with ...

MARCH 28, 2019

Why Payors Should Evaluate Provider-Based Specialty Pharmacies Seeking Network Access

Health-system specialty pharmacies are emerging across the United States to improve access to specialty ...

NOVEMBER 27, 2018

With Little Guidance, Prescribers Handing Out Opioid Prescriptions to Children

ORLANDO, FLA.—Research presented at the AMCP's 2018 Nexus meeting is shedding light on the use of opioids ...

OCTOBER 26, 2018

SOC, IG Therapy Highlighted in New EMD Serono Specialty Digest

Las Vegas—The use of site-of-care programs to manage the cost of infused specialty drugs increased ...

MAY 1, 2018

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