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The Knox-Keene Health Care Service Plan Act of 1975 is a set of Californian laws that regulate Healthcare Service Plans. Under these laws, pharmacy benefit managers with contracts to Health care service plans are required by law to be registered with the Department of Managed Health Care to disclose information. [58] SB 966: Pharmacy benefits
A pharmacy benefits manager is what it sounds like: PBMs manage prescription drug benefits, which involves coordinating across a laundry list of stakeholders—that includes health insurers ...
Pharmacy benefit managers (PBMs) are in the crosshairs of Republicans and Democrats in Congress but have so far dodged any new litigation or reforms that had been targeted for inclusion in last ...
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 ...
Catamaran Corporation (formerly SXC Health Solutions) is the former name of a company that now operates within UnitedHealth Group's OptumRX division (since July 2015). It sells pharmacy benefit management and medical record keeping services to businesses in the United States [3] and to a broad client portfolio, including health plans and employers. [4]
Administrative data are electronic records of services, including insurance claims and registration systems from hospitals, clinics, medical offices, pharmacies and labs. For example, a measure titled Childhood Immunization Status requires health plans to identify 2-year-old children who have been enrolled for at least a year.
The prescription insurance industry — and particularly PBMs, the powerful middlemen at its heart — get blamed for pharmacies closing down and patients paying too much for medicine.
Coverage is available only through insurance companies and HMOs, and is voluntary. Enrollees paid the following initial costs for the initial benefits: a minimum monthly premium of $24.80 (premiums may vary), a $180 to $265 annual deductible, 25% (or approximate flat copay) of full drug costs up to $2,400.