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PBMs regulate how much community pharmacies are reimbursed by drug companies and health insurance plans for the drugs they sell. PBMs are not required to share how these rebate rates are calculated and this can result in local pharmacies being paid back less or the same as the sticker prices of the drugs themselves. [30]
The Trump administration sought in 2020 to make rebates illegal for Medicare prescription drug plans by removing the safe harbor protection that shields rebates from federal anti-kickback laws.
In 2023, the top three PBMs dispensed the majority of specialty drugs in the U.S. at 68 percent, a double-digit hike from when it dispensed 54 percent of specialty drugs in 2016.
In 1993, Version 2.0 of HEDIS was known as the "Health Plan Employer Data and Information Set". [2] Version 3.0 of HEDIS was released in 1997. [ 1 ] In July 2007, NCQA announced that the meaning of "HEDIS" would be changed to "Healthcare Effectiveness Data and Information Set."
Pharmacy benefits managers (PBMs) are employing new strategies to squeeze independent pharmacies, even as the industry faces pressure from the federal government, which is looking for ways to curb ...
Prescription drug monitoring programs, or PDMPs, are an example of one initiative proposed to alleviate effects of the opioid crisis. [1] The programs are designed to restrict prescription drug abuse by limiting a patient's ability to obtain similar prescriptions from multiple providers (i.e. “doctor shopping”) and reducing diversion of controlled substances.
The Pharmaceutical Care Management Association (PCMA) is an American national trade association representing pharmacy benefit managers.According to the association's mission statement, PCMA advocates on behalf of its member companies, which claim to improve affordability of prescription drugs and quality of care through the use of tools such as electronic prescribing (e-prescribing), [1 ...
Patient-reported outcomes are important in a regulatory context. The US Food and Drug Administration (FDA) has issued formal Guidance to Industry on PROs in label claims [24] and the European Medicines Agency (EMA) has produced a reflection paper on HRQoL. [25] Increasing numbers of regulatory submissions for new drugs provide PRO data to ...