CMS transparency rules and AI could bring “Expedia-like” drug price comparisons for consumers, but payer compliance to transparency rules remains low.
News|Articles|January 1, 2003
Incorporating an ethical template into pharmacy benefit decision-making
If asked, could you present the underlying rationale for your pharmacy benefit coverage decisions? When considered from the consumer or employee perspective, why should they consider the payors or providers of their drug benefit legitimate decision-makers in limiting their healthcare policies?
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A new Spherix Global Insights survey shows providers want administrative support for prior authorization while patients prioritize access and affordability
In this discussion, Ohio State economist Eric Seiber, Ph.D., explains how inconsistent claims-data definitions can skew estimates of first-episode psychosis and why standardization matters for early treatment and sustainable payment models.
CMS’ mandatory GLOBE drug model ties some Medicare Part B rebates to global prices, but cuts projected savings sharply amid shifting Part D premiums.
Bill Kerr of Avalon Heath Solutions says incorporating Z codes into CPT codes for lab and genetic testing would add needed specificity, reduce waste and possibly head off fraud.
States have to turn that information into medical frailty determinations that are clinically credible, consistent, and workable across large Medicaid populations.
A meta-analysis found steatotic liver disease in 75% of patients with sleep-disordered breathing and that CPAP lowered liver enzymes but not liver fat.
Some predicted that drugmakers might boost launch prices to make up for Medicare drug negotiations shrinking profits. Harvard researchers find no evidence of that happening so far.
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