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In states with licensing regulations, the increase in premiums was 0.3% lower than the national average, while in states without these regulations, it was 0.4% above the average. [59] However, PBMs argue that enforcing this regulation will only drive up drug costs and increase coverage premiums for all parties. [59]
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.
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 ...
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.
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
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 ...
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." [3] In current usage, the "reporting year" after the term "HEDIS" is one year following the year reflected in the data; for example, the "HEDIS 2009" reports, available ...
PBMs are facing increased government scrutiny over their role in escalating costs of prescription drug. Wells Fargo in a statement said it was reviewing the lawsuit.