Wrapping Your Arms Around the Medical Benefit Drug Spend

Prescription drugs are covered through a health plan’s pharmacy or medical benefit. This determination depends on whether the drug is self-administered or given in a clinical setting. While the reimbursement process through the pharmacy…

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Leveraging PBM KPIs for Better Decision-Making

The role of pharmacy benefit managers (PBMs) has evolved into a complex and vast landscape from the days of a claims adjudicator. Strategic PBM oversight and performance measurement are critical to ensure…

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New Medicare Opioid Management Initiatives

The Centers for Medicare & Medicaid Services (CMS) held a webinar on December 27, 2018, to help providers understand the new guidance for prescribing opioids to Medicare beneficiaries – and if you…

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