Pharmacists, insurers, Medicare align to promote qualityprescribing
Washington, D.C.-Insurers, pharmacists and Medicare officialshave established a formal partnership called the Pharmacy QualityAlliance (PQA) to improve measurement of pharmacy performance. Amajor function of the alliance will be to develop quality measures,new payment models and information systems to promote appropriatedrug treatment and to compensate pharmacists for supporting theseefforts.
WASHINGTON, D.C.-Insurers, pharmacists and Medicare officials have established a formal partnership called the Pharmacy Quality Alliance (PQA) to improve measurement of pharmacy performance. A major function of the alliance will be to develop quality measures, new payment models and information systems to promote appropriate drug treatment and to compensate pharmacists for supporting these efforts.
PQA members, including America's Health Insurance Plans (AHIP), the National Association of Chain Drug Stores (NACDS) and the National Community Pharmacists Assn. (NCPA), already have agreed on standardized electronic messages that will make it easier for Medicare Part D plan sponsors to explain why a certain prescription is not covered. Such "reject codes" received by retail pharmacies may result from a need for prior authorization, quantity limitations, coverage under Part B and pharmacy network status under the system developed by PQA leaders.
The next initiative aims to make greater use of pharmacists to promote generic drug utilization, with expanded e-prescribing being another area where pharmacists may seek to collaborate.
David Calabrese of OptumRx Talks New Role, Market Insulin Prices and Other Topics 'On His Mind'
April 13th 2023In this month’s episode of the "What's On Your Mind podcast," Peter Wehrwein, managing editor of MHE connects with the now Chief Clinical Officer of OptumRx Integrated Pharmacies, David Calabrese. In this conversation, David touches on his transition in January as OptumRx’s former chief pharmacy officer and market president of health plans and PBMs to his new role as Chief Clinical Officer where he now focuses more on things such as specialty pharmacy to home delivery — with an overall goal of creating whole-patient care. Throughout the conversation, Calabrese also touched on the market’s hot topic of insulin prices and behavioral health services within the OptumRx community, among other topics.
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Upended: Can PBM Transparency Succeed?
March 6th 2024Simmering tensions in the pharmacy benefit management (PBM) industry have turned into fault lines. The PBMs challenging the "big three" have formed a trade association. Purchaser coalitions want change. The head of the industry's trade group says inherent marketplace friction has spilled over into political friction.
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Briana Contreras, editor of Managed Healthcare Executive, spoke with Nancy Lurker, CEO and president of EyePoint Pharmaceuticals. Nancy shared a bit about EyePoint and how the organization’s innovative therapies are addressing patient needs through eye care, and most importantly, she addressed C-Suite positions like the CEO role. Nancy shared advice for those seeking to reach the CEO level, especially toward women in healthcare and other roles, and what it takes to run a biopharma company.
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The deliberate disconnection of Change Healthcare to ring fence a cyberattack entered its seventh day today. Prescribers are finding ways to get pharmacy claims processed, and UnitedHealth Group says disruption to the dispensing of prescriptions has been minimal. But independent pharmacies want more information and protection from financial consequences from pharmacy benefit managers.
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