For physicians like Terrence Regan, MD, a Urologist in Florida, prior authorizations are limiting access to important treatments for patients and are draining physician offices of resources and time. According to the American Medical Association, 92% of care delays can be traced back to prior authorization requirements and 1 in 4 patients in 2021 will […]
Author Archives: ACMA
Field Reimbursement Now-Controversy between the FDA and Biogen
On July 9, the current acting FDA Commissioner Janet Woodcock called for the Office of Inspector General to investigate the agency’s close ties with Biogen who had submitted its Alzheimer’s drug, Aduhelm for FDA approval. Aduhelm is a monoclonal antibody for the treatment of Alzheimer’s disease, was extremely controversial when it was first approved due […]
What is an Insurance Exclusion List?
A drug exclusion list is a list of medications that will not be covered by a health plan for any reason. The drug is not on formulary and there are no loopholes to gaining approval. What is a formulary? A formulary is a list of prescription drugs covered by a prescription drug plan or another […]
Summary: Help Process Insurance Claims and Payments
Handling insurance claims and processing insurance are important functions within the pharmacy. There are roles dedicated to dealing with insurance claims, payer policy, and prior authorization. Dr. Amanda DeMarzo, PharmD, MBA, PACS is the Associate Director, Patient Access with the National Board of Prior Authorization Specialists. She encourages enhancing patient access through education and certification. […]
What are Biosimilars?
Biologic products are drugs that have regulation by the United States Food and Drug Administration. They have utility to diagnose, prevent, treat and cure medical diseases and conditions. They are usually large and complex molecules and are harder to characterize than small molecule drugs. Common and familiar biologics include etanercept (Enbrel®), infliximab (Remicade®), adalimumab (Humira®), […]
Summary: Patients, Need a Helping Hand with Prior Authorization?
Prior Authorization is often viewed as a complex and confusing subject. It complicates the patient care process via a series of troublesome obstacles that are regularly associated with insurance policies. Dr. Amanda DeMarzo, an advocate of improving patient care outcomes via improved methods of training and education, as well as a leading figure of the […]
