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In an unusual move, an audit of commercial health plans by Tennessee officials found that Express Scripts, one of the largest pharmacy benefit managers in the United States, violated state laws in its dealings with pharmacies, according to newly released documents.
The study cohort included 670 patients who were diagnosed with PsA of at least a 3 month duration and have active plaque psoriatic skin lesions or a documented medical history of plaque psoriasis. READ MORE: Significant Knowledge Gap Exists in Patient Awareness of Psoriatic Disease The study found that 54.2%
This led researchers to explore a specific region of the world in order to better document patients’ understanding of the disease. The prevalence of psoriasis in the Gulf countries is not well-documented; however, recent studies suggested that psoriasis affects 0.5%-5.3%
image credit: syahrir / stock.adobe.com While data shows that obesity has been on the rise among children in recent history, the overall complications spurred on by childhood obesity have been well documented. 1 “Guidelines recommend treating obesity with medications and lifestyle changes.”
The use of specialty medicine has grown rapidly in recent decades, fueling parallel growth in the number of specialtypharmacies that serve patients who are prescribed specialty medications. Results of this work were published in the Journal of Managed Care & SpecialtyPharmacy in October 2022.
When Zepbound is covered, prior authorization is usually required, and the patient may need to meet clinical requirements such as a BMI of 30 or more or a BMI of 27 or more with a comorbid condition like hypertension or Type 2 diabetes, and documented weight management efforts like a low-calorie diet and increased physical activity.
Some specialtypharmacies will create their own version of Mounjaro, known as compounded tirzepatide. You can also log in to your health insurance portal to access policy documents. The two you want to look for are the drug list (also called a formulary, pharmacy benefits document, or PDL) and the summary of benefits.
While SaveOnSP is the nominal target of the lawsuit, it claims to expose one of the failings in the US health insurance sector, adding fire to an increasingly heated exchange between pharma manufacturers and pharmacy benefit managers (PBMs), which have blamed each other for high medicine prices in the US.
According to court documents cited by Reuters, annual sales of Exforge in the US were over $400 million before generic versions reached the market. In 2020, it also paid $345 million to resolve a series of cases brought by the federal government under the Foreign Corrupt Practices Act (FCPA).
Today, we published the 2024 PQA Annual Report, which documents our progress towards our strategic goals. Successfully piloting pharmacy measure concepts focused on blood pressure and A1c improvement and control. Successfully piloting PQA’s endorsed measure focused on specialtypharmacy turnaround time.
As a specialty medication , Humira requires specific handling, administration, and monitoring, so you have to get it from a specialtypharmacy or other designated location. It’s also a good idea to review your Summary of Benefits and Coverage document to fully grasp the expenses,” Dr. Youssouf says.
The SpecialtyPharmacy Abandonment Rate TEP will define a measure around primary abandonment rate of specialtypharmacy prescriptions. The Health Equity TEP will review how PQA measures can be a tool to foster health equity by producing recommendations related to stratification for quality measures.
Chief Executive Officer Micah Cost opened the summit with an update on the state of the alliance. Cost highlighted progress towards completion of PQA’s strategic plan, Blueprint PQA 2025. Each panel session featured PQA staff and pilot project participants or other industry leaders, who detailed their approach, experience and outcomes.
Ensuring the quality of medication use is critically important for rare disease patients, payers, clinicians, specialtypharmacies and everyone with a role in the care process. February 29 was Rare Disease Day, providing an opportunity to raise awareness of the impact of rare diseases.
We continue to play a central role in driving meaningful improvements and positive changes related to medication safety, adherence and appropriate use.The 2023 PQA Annual Report documents our progress towards Blueprint PQA 2025. The data can also show short term results.
Pharmacists can get trained credentials, get up to speed and enrolled to generate $20, $30, $50 a month per patient in managing their medications a little better and documenting it.
Prior authorization might require the healthcare provider to submit documentation of your symptoms, diagnosis, specialist visits, or other information. Specialty drug requirements Specialty drugs are expensive medications used to treat complex conditions. Arora says that it’s often required due to the cost of the medication.
Jangus Whitner, Director of Pharmacy Services at PrimaryOne Health also shared the results of a qualitative research study that documented direct patient experiences using the 340B program on injectable diabetes medications. Omnicell can be a valued partner in this effort.
They can collect documentation on prior preventive therapies, baseline MMDs, and follow-up outcomes to support prior authorization, including site-of-care arrangements. of participants discontinued due to adverse effects.
Pulmonary function tests and provider documentation were manually reviewed to confirm asthma diagnoses, while individuals with other pulmonary diseases were excluded. 1 The study also observed that 65% of patients had a documented visit with an asthma specialist during the follow-up period.
We all share the same electronic health record and document every patient interaction in the health record, and we have very easy access to reach out to the patient's provider to let them know of any questions or concerns that the patient has regarding their medication.
If a discrepancy is found, the pharmacy nurses will hold the shipment, and a clinical intervention will be communicated to the provider. Results American Oncology Network (AON) Pharmacy collected data on waste and cost avoidance from February 2023 to September 2023. During this time frame, the pharmacydocumented 152 interventions.
Other documented causes of secondary dysmenorrhea include fibroids, adenomyosis, infection, myomas, obstructive reproductive tract anomalies, and ovarian cysts About the Author Yvette C. Dysmenorrhea, also known as painful menstruation, is the most commonly reported menstrual symptom among females during the reproductive years.
It’s also helpful to hear from managed care experts—understanding their concerns and what documentation is needed to ensure patients can get coverage for the latest treatments. I love that OPC is positioned so close to ASCO because pharmacists often can’t attend large meetings due to travel restrictions and limited funding.
We just must do a good job of documenting them and develop that clinical evidence base that supports it. Pharmacy Times: How do evolving guidelines influence the integration of CGMs into standard clinical practice for T2D? 100% of them said a GLP-1 would be more effective if you use the CGM with it, unanimous.
The manufacturer reported that, as part of the NDA review, they have not highlighted any technical concerns related to the submitted documentation or testing of OLC. The CRL was received after OLC’s initial Prescription Drug User Fee Act date of June 28, 2025, and cited for deficiencies that are unrelated to OLC itself.
Pharmacy Times: What are the most significant benefits of CGM adoption for individuals with type 2 diabetes? Sayer: The most documented, most significant benefits If you take a look at the trials we've run, first of all, you always see an A1c reduction, because average glucose values go down and A1c follows.
In some cases, however, it might mean your healthcare provider needs to submit documentation of symptoms, specialist visits, or other information to BCBS. However, they only apply for drugs you get from the pharmacy. In others, you might need to try other medications first, which is a process called step therapy.
27 of this year to meet the requirements, as long as they are making documented efforts to finalize data connections, of course. In fact, wholesalers and repackagers had until May 27, 2025 (following this day, full-unit traceability would be mandatory), a date that has officially passed.
The properties of thimerosal were documented to contribute to the safe use of multidose vials and packaging of vaccines, such as seasonal and pandemic influenza vaccines. Thimerosal is a mercury-containing compound that has been widely used as a preservative in some biological and drug products since the 1930s.
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