Discover the pivotal role of Pharmacy Benefit Managers (PBMs) as intermediaries between patients, pharmacies, and insurance companies in the prescription drug process.
Author Archives: ACMA
Navigating Prior Authorizations in Dermatology
Explore the challenges and solutions to the rising costs of dermatologic medications and the impact of prior authorization on patient care. Learn about the driving factors behind the increasing prices of biologics and common dermatologic drugs, and the efforts to improve the prior authorization process for healthcare providers and patients.
340B Drug Pricing & Prior Authorizations
A growing number of complex, expensive medications are entering the market. At the same time, health insurance companies, also called payer, are increasingly relying on utilization management to control healthcare costs by influencing patient care decisions. Common utilization management tools include prior authorizations, step therapy, predeterminations, and preauthorizations.
Utilization Management: Here’s What You Need to Know
A growing number of complex, expensive medications are entering the market. At the same time, health insurance companies, also called payer, are increasingly relying on utilization management to control healthcare costs by influencing patient care decisions. Common utilization management tools include prior authorizations, step therapy, predeterminations, and preauthorizations.
What Is Biomarker Testing?
Prior authorization for biomarker testing has been a topic of discussion due to California’s SB-535T legislation. Prior authorizations (PA or prior auth) require physicians and other healthcare providers (HCPs) to obtain approval from a health insurance company prior to providing specific services to patients. By requiring prior authorizations, health insurance companies prevent or delay life-saving tests, procedures, or medications.
5 Tips to Become a Field Reimbursement Manager
Field reimbursement managers (FRMs) are the backbone of a life science organization. FRMs support commercial (i.e., sales teams) with the patient reimbursement journey, ensuring patients receive therapy in a timely and cost-effective manner and assisting life science organizations with their primary objective of improving patient lives.
The Impact of Prior Authorization on Patient Compliance and Adherence
As medications become more intricate and expensive, medication access barriers prevent patients from acquiring their prescriptions and continuing medication regimens. The prior authorization (PA or prior auth) process is one of the access obstacles patients face when trying to acquire their medications.
A Guide to Selecting the Best Medical Billing Company
Healthcare providers (HCPs) today must see more patients, provide more complex medical services, and complete detailed documentation more efficiently. Consequently, there is little time left to deal with billing. An HCPs’ financial stability and their medical practice’s future depend on their medical billing and coding quality.
Electronic Prior Authorization Reform: What’s Next?
The legislation will streamline the prior authorization process for the more than 28 million Medicare Advantage members. Medicare Advantage (MA) plans, sometimes called “Part C” or “MA Plans,” are Medicare-approved plans from private companies offering an alternative to original Medicare for health and medication coverage.
4 Tips for Prior Authorization Success
Prior authorizations (prior auths or PAs) are a cost management tool utilized by insurance companies. PAs increase administrative costs for HCPs and create a healthcare obstacle for patients. HCPs depend on prior authorization approvals and insurance payments to remain in business. Healthcare providers (HCPs) must master a productive prior authorization workflow to improve productivity and revenue.
