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What You Need To Know About Medicare Part B Step Therapy: AMCP Nexus 2022
Yuqian Liu, Pharm.D., and Michelle Booth, Pharm.D., of Magellan Rx Management, discuss the background and consequences of step therapy in Medicare Part B in an interview prior to their session at the AMCP Nexus 2022 meeting in National Harbor, Maryland.
This interview was recorded prior to the meeting.
CMS has estimated that step therapy for Part B drugs in Medicare Advantage plans could save the Medicare program over $1.9 billion from 2020 to 2029 years, according to Yuqian Liu, Pharm.D., senior director of specialty clinical solutions at Magellan Rx Management.
Liu said CMS has estimated that step therapy will save beneficiaries about $62 million in out-of-pocket costs during the same period.
Liu and her colleague, Michelle Booth, spoke to Managed Healthcare Executive® prior to their presentation about Part B step therapy in Medicare Advantages scheduled for today at AMCP Nexus 2022 meeting in National Harbor, Maryland.
Michelle Booth, Pharm.D., also a senior director of specialty clinical solutions at Magellan, said most plans were cautious about jumping into step therapy.
"A lot of folks started small (with step therapy) and then expanded based on where their utilization was and where they kind of felt like the biggest bang for their buck was," Booth told Managed Healthcare Executive®.
Cost savings for the plans were quite high from the program at first , then decreased after the first year. However, Booth feels savings have been "fairly stable."
Booth also noted that some time and effort went into developing care coordination programs that CMS had indicated would be required but then changed course and decided not to require them.
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October 20th 2023The Minnesota-based pharmacy benefit manager says a program that resulted in patients switching from two incretin therapy prescriptions to one yielded $7,500 in savings per patient and a total of $3.5 million.
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The Benefits of ML, AI Use in Managed Care Pharmacy | AMCP Nexus 2023
October 19th 2023Adopting evolving computer system tools like artificial intelligence and machine learning in managed care pharmacies have resulted in efficiency when addressing the challenges they are faced with, according to Jessica Hatton, PharmD, BCACP, associate vice president of Pharmacy at CareSource and Nick Trego, PharmD, senior vice president of Clinical Analytics and Client Services at HealthPlan Data Solutions, Inc.
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Outcomes From Horizon BCBS of New Jersey Oncology Home Infusion Program | AMCP Nexus 2023
October 19th 2023The program yielded savings of $25,000 per patient in its pilot phase but is not expected to produce savings as a routine offering because reimbursement for home infusion was matched to reimbursement at a facility. Horizon executive Timothy O’Shea, Pharm.D., M.S., says cost savings were a “secondary outcome” of the program and noted the high patient satisfaction.
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