With so many healthcare options available in the United States, it can be difficult and confusing choosing the right option for you. In this article, we will explain the differences between Medicare vs. Medicare Advantage. To start, Medicare Advantage provides a fixed set of options for you whereas Medicare provides you with a “buffet” style […]
Category Archives: blog
What are Copay Maximizers and Accumulators?
A recent article in the American Journal of Managed Care shed light on copay maximizer strategies among generics manufacturers. But not many patients understand how drug manufacturers are incorporating copay maximizers and accumulators in their reimbursement strategies. As a widespread challenge for patient access, copay accumulators and maximizers eliminate the altruistic nature of the patient assistance […]
Prior Authorizations are becoming a bigger burden- Now what?
For physicians like Terrence Regan, MD, a Urologist in Florida, prior authorizations are limiting access to important treatments for patients and are draining physician offices of resources and time. According to the American Medical Association, 92% of care delays can be traced back to prior authorization requirements and 1 in 4 patients in 2021 will […]
Field Reimbursement Now-Controversy between the FDA and Biogen
On July 9, the current acting FDA Commissioner Janet Woodcock called for the Office of Inspector General to investigate the agency’s close ties with Biogen who had submitted its Alzheimer’s drug, Aduhelm for FDA approval. Aduhelm is a monoclonal antibody for the treatment of Alzheimer’s disease, was extremely controversial when it was first approved due […]
What is an Insurance Exclusion List?
A drug exclusion list is a list of medications that will not be covered by a health plan for any reason. The drug is not on formulary and there are no loopholes to gaining approval. What is a formulary? A formulary is a list of prescription drugs covered by a prescription drug plan or another […]
What is the 340B Drug Pricing Program?
The 340B Drug Pricing Program allows for some healthcare facilities to acquire drug products from manufacturers at a substantially lower cost. This program stretches federal resources to expand access to communities. The discount drug products will provide therapy to patients who cannot afford them. According to the Health Resources and Services Administration (HRSA), enrolled facilities […]
The Impact of Non-Medical Switching
Non-medical switching is a discussion that happens every day for some physicians. Insurance companies and P&T committees change formularies resulting in therapy changes. Patients have to endure these changes or pay the difference. We are approaching that time of year when we begin to see more of these formulary changes. Patients purchased their insurance plans […]
What is White Bagging?
White bagging is a process for providers to receive medication from a specialty pharmacy directly. This is in lieu of buy and bill or brown bagging practices. Previously, we discuss Buy and Bill and brown bagging in a physician practice. In the blog we go over what the benefits and challenges of Buy and Bill […]
What is Brown Bagging?
Typically, we think of brown bags when we think of school lunches. As kids, we would go to school with our brown bags with what our mothers may have made for us. Depending on the time and location of your primary education, the brown bag lunch is a daily practice of pride or shame. Especially […]
What is Buy and Bill?
Buy-and-bill is a process for physician offices to acquire medications that providers can administer in the office. The “buy” part refers to providers who are responsible for ordering and purchasing the drug. The “bill” part refers to providers billing directly to third-party payers for reimbursement. In addition, through this system, the provider also takes on […]
