Drug Topics

JUNE 5, 2025

Whether it's trying to check out at a crowded store or navigating complex prescription issues, barriers frustrate people—and pharmacies are no different. From prior authorizations to insurance roadblocks, each decision a pharmacy makes can either ease or complicate that experience.

Health and Personal Care Stores

Drug Topics

JULY 15, 2025

They will have insurance coverage, and that has helped tremendously to be able to adjust insulin doses. We have seen that explode, really kind of side by side with the GLP-1 medications to the point where now anyone on insulin, any type of insulin, even just a once-a-day, long-acting insulin, typically now has access to CGM.

Insurance Coverage

Pharmacy Times

JULY 16, 2025

Importantly, ACIP’s recommendations do have a strong influence, if not a mandate, on health insurance companies with respect to coverage and co-payments for immunizations as well as the Vaccines for Children Program, which provides coverage for access to vaccines for those who are 18 years or younger.

Vaccines

Drug Topics

JULY 1, 2025

They look at the list and they prioritize who they want to take on and who they don't want to take on based on their insurance plan and their drugs. That's dependent upon their insurance plan and the medications they use. I am hearing that some independents are just creating a wait list. That is a real problem.

Health and Personal Care Stores

Drug Topics

AUGUST 13, 2025

Large corporations now own the entire health care supply chain—from insurance plans to PBMs to chain pharmacies—making it harder for community pharmacies to compete fairly or access the same patient base. Past legal or disciplinary issues can significantly impact a pharmacy’s ability to bill medical services.

Mail-Order Pharmacies

Pharmacy Times

AUGUST 1, 2025

PBMs are more powerful and influential than ever as they become extensions of major health insurers, acquire independent pharmacies, and create new business lines to funnel prescriptions through. In doing so, the law will prevent PBMs from steering patients to their own higher-cost specialty pharmacies.

Specialty Pharmacies

Pharma Marketing Network

JUNE 13, 2025

High costs, skin invasiveness, and insurance limitations act as real barriers, not just for adoption, but for long-term engagement. No insurance pre-authorizations. While reimbursed in many cases for insulin-dependent users, these costs remain prohibitive for the 70%+ of people with type 2 diabetes who are not on insulin therapy.

Specialty Pharmacies

Pharmacy Times

AUGUST 11, 2025

7 MTM is crucial for transitions of care, especially if a patient fills medications at multiple pharmacies. Most MTM platforms use health plan adjudication data, allowing pharmacists to see any medication billed through the patient’s insurance, even if it was not filled at their pharmacy.

Hospitals

Drug Topics

AUGUST 12, 2025

Advancements in prescription technology are poised to change that by ensuring prescriptions arrive at pharmacies complete and ready to fill,” Bedel said. That’s why many of us, including me, became pharmacists.”

Specialty Pharmacies

Pharmacy Times

JULY 22, 2025

Additionally, the role of pharmacy benefit managers (PBMs) cannot be overlooked. These third-party administrators act as intermediaries between drug manufacturers, pharmacies, and insurance companies. PBMs negotiate prices, establish formularies, and process claims, while also creating preferred networks of pharmacies.

Mail-Order Pharmacies

Drug Topics

JULY 5, 2025

Drug Topics: How do ACIP recommendations affect broader aspects of vaccine access and utilization, such as insurance reimbursement or public health programs? So I think once they're not recommended, insurances aren't going to cover them, and some of these vaccines are very expensive and most people can't afford them.

Patient Care

Pharmacy Times

JULY 21, 2025

The most common concerns include the following 1,3-5 : • Cost and insurance barriers: Affordability remains a major barrier, as patients have difficulty accessing CGMs due to high out-of-pocket costs or limited insurance coverage.

Compounding Pharmacies

Pharmacy Times

JULY 12, 2025

3 Her program focuses on an appointment-based model and has a cash-based payment model, although they are able to bill some insurances for the visit. Naloxone Access Is Life-Saving Novak also pioneered naloxone prescribing at her PGY1 site, Bryant Family Pharmacy, under Arkansas’ first statewide protocol for pharmacist clinical services.

Independent Pharmacies

Viseven

JULY 4, 2025

Patient data is everywhere, from electronic health records to insurers, or social media. Admit that data silos are holding you back Life sciences brands have access to vast amounts of data – prescription claims, sales force metrics, specialty pharmacy records, advertising performance, qualitative physician insights, and more.

Communication

Pharmacy Times

AUGUST 13, 2025

Cost, insurance, and health care resources will dictate who can use the treatment. The approval continues to show the growth of therapeutic options for those with R/R DLBCL, as well as how BV-R2 offers improved survival and quality of life to a larger range of patients. The recommended dose is 1.2

HIV Treatment and Prevention Agents

Pharmacy Times

JULY 24, 2025

Christopher Ho, PharmD, BCPS, manager of pharmacy telehealth team at Northwell Health, pointed out that many patients with HFpEF are older and lack commercial insurance, making it harder to access branded therapies. Clinical and Practical Barriers Despite the drug’s potential, cost and access are ongoing concerns for finerenone.

HIV Treatment and Prevention Agents

Drug Topics

JUNE 23, 2025

Successful RCM implementation can help pharmacies recover significant funds, with Outcomes reporting nearly $3 million recovered for clients in 2024 and 2025.

Patient Care

Pharmacy Times

JULY 4, 2025

1 For these reasons, the authors conducted this study to evaluate the clinical success and patient outcomes following the mandatory conversion from Humira to a biosimilar because of insurance-related restrictions. The most common reason for exclusion was the patient opting out of clinical follow-up with the specialty pharmacy team.

Specialty Pharmacies

Pharmacy Times

JULY 25, 2025

Additional considerations for selection between oral cephalosporin agents include differences in bioavailability and absorption, specific site of infection and the ability of drug to concentrate at that site, local resistance patterns, insurance coverage, available formulations, and cost to the patient.

HIV Treatment and Prevention Agents

Drug Topics

JULY 24, 2025

3 ACIP recommendations are often looked at as guidelines by providers and insurance to determine the vaccine schedule and what is covered under insurance and the VFC program. “As One concern was the criteria to diagnose autism changes and another included reliance on aggregated data for the analysis.

Specialty Pharmacies

Pharmacy Times

JULY 1, 2025

Additionally, pharmacists are also vital in identifying financial assistance programs or navigating specialty pharmacies or mail-order services. Because] insurance and cost barriers can be difficult for patients, pharmacists can help patients navigate copayment programs and the prior authorization process.”

HIV Treatment and Prevention Agents

Pharmacy Times

JULY 23, 2025

Pharmacists are pivotal in patient counseling, therapy selection, and navigating insurance challenges, ensuring comprehensive diabetes management. She also noted the insurance considerations, including involvement with formularies and prior authorization, that come into play when making these decisions.

Insurance

Pharmacy Times

JULY 22, 2025

4 Though the US still stops short of requiring testing outright, this marks a critical turning point—shifting responsibility onto clinicians and paving the way for broader insurance coverage and adoption. Real-World Evidence, Emerging Therapies, and Demonstrating Value Technological advances are accelerating this progress.

Compounding Pharmacies

Pharmacy Times

JUNE 16, 2025

Second, it does not address the core issues of higher prices, such as the use of rebates by insurers. Kennedy Jr, is permitted to develop a new rule that ties American drug prices to those of other nations. First, this may be blocked by a federal judge again. And finally, the most favored nation pricing model is unworkable.”—

Compounding Pharmacies

Pharmacy Times

JULY 28, 2025

Treatment selection is influenced by insurance, cost, and patient-specific factors due to the lack of direct RCT comparisons. 7 Based on a lack of head-to-head randomized clinical trials (RCTs), selection of the most appropriate VMAT2 inhibitor is routinely related to insurance approval, affordability, and patient-specific characteristics.

Compounding Pharmacies

Pharmacy Times

AUGUST 12, 2025

We connect patients with [teplizumab] compass navigators to help with insurance approvals in a copay program, logistics, and patient education. You can find that online. Just search that terminology, "Tzield compass navigators."

Specialty Pharmacies

The Checkup by Singlecare

JUNE 5, 2025

Some health insurance formularies cover Mounjaro, while others list it as a nonpreferred drug. Even if your BCBS health plan covers Mounjaro, you may need to get prior authorization from the insurance company to confirm they’ll pay for it. Without insurance, Mounjaro costs an average of $1,486 per 4, 0.5 mL of 5 mg/0.5

Insurance

Pharmaceutical Commerce

JUNE 18, 2025

Conference Connect: Determining the Future of Specialty Pharmacy Nicholas Saraceno, Editor June 18th 2025 Article The Asembia AXS25 Summit strives to explore ways to improve patient outcomes, especially for rare and complex diseases.

Specialty Pharmacies

Pharmacy Times

JULY 1, 2025

You also look at sometimes the unfortunate situation of the patient's insurance, for example, no longer covering the medication, whether it's an insurance formulary change or, for example, a patient switches insurances due to a job change. We on our own help to navigate patients through that process as well.

Specialty Pharmacies

Pharmacy Times

JUNE 17, 2025

That means that pharmacists in the twilight of their career have, at some point, filled a prescription, engaged in drug utilization review, filed insurance claims, and counseled per the Omnibus Budget Reconciliation Act of 1990 regulations for many of the products now found in front of the counter.

Compounding Pharmacies

Pharmacy Times

JUNE 23, 2025

Goldman and Isaacs emphasize the importance of identifying at-risk patients through various health care touchpoints, including doctor's offices and pharmacies, and advocate for routine glucagon prescription and insurance coverage. But I also think everyone should have a ready-to-use cover on their insurance.

Compounding Pharmacies

Pharmacy Times

JULY 3, 2025

Getting this passed would mean broadening coverage within CMS, and then, hopefully, private insurers would follow suit. CMS leads the way when it comes to new therapies and approval, so hopefully, this means broadening access to both private and government-based insurers.

Compounding Pharmacies

Drug Topics

JUNE 25, 2025

Investigators find that current practices among pharmacists are not fully in alignment with American Diabetes Association (ADA) guideline recommendations for glucagon use, with frequently identified barriers including cost, patient health literacy, and insurance coverage. of patients on a short-acting insulin and 2.3%

Insurance Coverage

The Checkup by Singlecare

JUNE 5, 2025

While health insurance plans do not always provide coverage of Zepbound for weight loss, coverage may be more likely if the drug is prescribed for sleep apnea. Many insurance plans often do not cover weight loss medications in general,” says Luis Vinas , a board-certified plastic surgeon at Palm Beach Gynecomastia Center.

Insurance

Pharmacy Times

JULY 24, 2025

Someone ended up donating a car, and they used the money to buy tires and insurance. Because the pharmacy is in a rural area, Loy-Helm explained, patients have her phone number. The patient was moving away and did not have a car. Loy-Helm jumped into action, mobilizing the staff and patients to raise money to buy her a car.

Independent Pharmacies

PharmExec

JULY 31, 2025

July 31st 2025 Undertreated but High-Risk: The Hidden Health Crisis Facing 50+ Americans Don Tracy, Associate Editor Leandro Boer, MD, PhD, VP, US general medicines, Amgen, explains why many high-risk Americans aged 50+ remain undertreated for cardiovascular disease, citing insurance gaps, risk misperceptions, and complex guidelines.

Communication

PharmD Live

JUNE 16, 2025

Journal of Managed Care & Specialty Pharmacy, 28 (3), 379–386. Why Do Patients Still Struggle With Adherence? The role of integrated medical and prescription drug plans in addressing racial and ethnic disparities in medication adherence. link] Brown, M. T.,  T., & Bussell, J. K. Medication adherence: WHO cares?

Hospitals