Explore the critical role of Prior Authorization (PA) in healthcare, its cost-control impact, and its significance in ensuring tailored medical treatments.
Author Archives: ACMA
Medicare Part D Out of Pocket Smoothing
Discover the transformative power of Medicare Part D Out-of-Pocket Smoothing in managing healthcare expenses. Uncover how this provision ensures financial predictability and improved healthcare access for Medicare beneficiaries, paving the way for a stable healthcare journey.
PBM Reform and Prior Authorization: What’s Next?
Discover the crucial role Pharmacy Benefit Managers (PBMs) play in drug pricing and accessibility. Uncover the counterintuitive fee structure and explore proposed reforms to improve transparency, reduce delays, and lower costs.
Understanding the Role of the PBM
Discover the pivotal role of Pharmacy Benefit Managers (PBMs) as intermediaries between patients, pharmacies, and insurance companies in the prescription drug process.
Navigating Prior Authorizations in Dermatology
Explore the challenges and solutions to the rising costs of dermatologic medications and the impact of prior authorization on patient care. Learn about the driving factors behind the increasing prices of biologics and common dermatologic drugs, and the efforts to improve the prior authorization process for healthcare providers and patients.
340B Drug Pricing & Prior Authorizations
A growing number of complex, expensive medications are entering the market. At the same time, health insurance companies, also called payer, are increasingly relying on utilization management to control healthcare costs by influencing patient care decisions. Common utilization management tools include prior authorizations, step therapy, predeterminations, and preauthorizations.
Utilization Management: Here’s What You Need to Know
A growing number of complex, expensive medications are entering the market. At the same time, health insurance companies, also called payer, are increasingly relying on utilization management to control healthcare costs by influencing patient care decisions. Common utilization management tools include prior authorizations, step therapy, predeterminations, and preauthorizations.
What Is Biomarker Testing?
Prior authorization for biomarker testing has been a topic of discussion due to California’s SB-535T legislation. Prior authorizations (PA or prior auth) require physicians and other healthcare providers (HCPs) to obtain approval from a health insurance company prior to providing specific services to patients. By requiring prior authorizations, health insurance companies prevent or delay life-saving tests, procedures, or medications.
5 Tips to Become a Field Reimbursement Manager
Field reimbursement managers (FRMs) are the backbone of a life science organization. FRMs support commercial (i.e., sales teams) with the patient reimbursement journey, ensuring patients receive therapy in a timely and cost-effective manner and assisting life science organizations with their primary objective of improving patient lives.
The Impact of Prior Authorization on Patient Compliance and Adherence
As medications become more intricate and expensive, medication access barriers prevent patients from acquiring their prescriptions and continuing medication regimens. The prior authorization (PA or prior auth) process is one of the access obstacles patients face when trying to acquire their medications.
