GeneDx’s Post

How Copay Accumulators Work: Copay accumulators are mechanisms used by health insurance plans that impact how financial assistance from pharmaceutical manufacturers is applied. Many drug manufacturers offer copay programs to help patients manage costs and access specialty medications. However, copay accumulators prevent these "outside payments" from being counted towards a patient's deductible and out-of-pocket maximum. This policy can significantly affect oncology practices and their patients, leading to several key issues: 1. High Financial Burden 2. Impact on Productivity 3. Treatment Adherence 4. Administrative Burden The Need for Change: To alleviate these challenges, it is crucial to advocate for policies that recognize and include manufacturer copay assistance in calculating patient deductibles and out-of-pocket maximums. This change would ease the financial burden on cancer patients, improve treatment adherence, and reduce the administrative load on oncology practices. For more information and support, visit our website or contact us directly. Visit us to know more: https://lnkd.in/dR2C4cMJ For Service call: + 1 864 650 6400 or, info@qualify.health #QualifyHealth #OncologyFinancialAdvocates #CancerCare #FinancialSupport #PatientAdvocacy #CopayAccumulator #FinancialToxicity #CancerCareCosts #OncologySupport #PatientAdvocacy #HealthcareAccess #SpecialtyMedications #MedicalFinancialAssistance

https://lnkd.in/ei4wVvWK The current system of health insurance started now almost 100 years ago in the 1920s (covering groups of teachers). Meant to benefit the less fortunate. The article quoted here studies hospitals using the 340B government regulation - offering drug purchasing discounts to hospitals situated mostly in critical access area. Small hospitals serving less fortunate groups of patients. Hospital price markup is a common strategy to survive the poor reimbursement from various health insurance agencies that pay a fraction of the claims submitted by hospitals. Maybe this needs to be carefully analyzed and adjusted across the board, and not necessarily zeroed in at the level of the poorest hospitals.

(WASHINGTON EXAMINER) - "FTC sues top three pharmacy middlemen over insulin prices." The suit targets the three largest pharmacy benefits managers: UnitedHealth Group’s OptumRx, CVS Health’s Caremark, and Cigna’s Express Scripts. Find A More AFFORDABLE Health Insurance Plan At: HI4E.org #PBMs #CongressTargetsPBMs #FTCSuesPharmacyMiddlemen #PharmacyBenefitsManagers #PBMs #ManagedCareOrganizations #MCOs #RisingDrugPrices #PrescriptionDrugPrices #RXDrugPriceHikes #PharmacyMiddlemen #TrumpDrugPriceControls #BidenHealthcare #TrumpDrugImportRules #CanadianDrugImports #HealthAndLifeSolutions #WashingtonExaminer #MedicarePartDDrugPrices #TrumpMedicareReforms #HealthInsurance4Everyone

Germany is set to examine its medical cannabis sector with proposed changes by the Federal Joint Committee (G-BA), potentially increasing the ease of prescribing cannabis.💊 If approved, over 70% of German physicians could prescribe cannabis without prior health insurance approval, significantly enhancing patient access. This adjustment could transform the market dynamics, shifting from a predominantly private market to a broader inclusion under health insurance coverage, which could lead to a major increase in accessible treatment for patients. Source: Business of Cannabis https://lnkd.in/d9TraJMa #CanXChange #CannabisExchange #CannabisIndustry #IndustrialCannabis #B2BCannabisPlatform #CannabisB2BMarketplace #CannabisEuropa #MedicalCannabis #CannabisCultivation #CannabisMarket News #SecureTrading #CannabisCommerce

Cost of oral chemotherapy...! Getting access to oral chemotherapy drugs may be somewhat complicated, depending on your prescription drug insurance coverage. IV chemotherapy drugs have been part of cancer treatment for a long time, and the health insurance system is set up to process and approve these prescriptions relatively quickly and easily. An established system is in place that allows pharmacies to get pre-certification from the insurance company. They then fill the prescription, knowing they’ll very likely be reimbursed by the insurance company. The patient doesn’t usually have to be involved in this process. Many oral chemotherapy drugs, however, aren’t part of this system yet. The pharmacy may not give you the drug unless you have confirmation that the insurance company has already approved it. If not, you’re required to pay the pharmacy directly when you pick up the prescription. Most people are unable to pay cash for drugs that may cost between $6,000 - $12,000 per month.

Take charge of your pharmacy benefits by understanding the significance of a Prescription Drug List (PDL). A PDL, or formulary, lists all the drugs covered by your health insurance, including both brand-name and generics. PDLs help manage costs and ensure access to essential medications. With 60% of people relying on prescription medications, knowing how to find out if your drugs are on your PDL is crucial for making more informed healthcare decisions and navigating insurance coverage effectively. SmithRx is here to educate and simplify the PBM process, making it seamless and transparent. Learn more about how PDLs work and why transparent PBMs are the future 👉 https://lnkd.in/gAEbpe7c

Value-based care better aligns payment incentives with care outcomes. Highmark Health has been leading the way in implementing value-based care in pharmacy as part of our #LivingHealth strategy. This Forbes article explores how other large health insurance companies are following our example: https://bit.ly/3GW4ra7

Just when you thought you had seen everything it gets worse. Think about this situation and try to wrap your head around it. Payers (like UHC and Elevance/Anthem) are requiring Rheumatologist and other specialist to use certain biosimilar drugs to treat their patients. No that's the not insanity part. As much as having a payer decide what drug a patient gets is crazy this gets much worse. For some of those drugs the amount the carrier will pay the doctor for that drug is less than what the doctor had to pay to buy the drug. Let me say that again, the carrier makes you use a certain drug then pays you less than the cost of the drug. Yes, you got that right. So let me get this right. These huge, very profitable, insurance companies feel like they can tell doctors what drug to use and then make them provide that drug at below cost? Yup, that seems logical, said no one ever! https://lnkd.in/euughH4P

Even with health insurance, most Americans struggle to meet their out-of-pocket cost for medications. While steps like the #Medicare price cap are one way to approach this challenge and attempt to rein-in spiraling costs, we need more transparency and clear, client-aligned solutions to bring about a broader market evolution to deliver lowest net cost while ensuring a superior member experience. #RxBenefits is proud to be a disruptive force for good on behalf of clients - and their members - and the role we play in optimizing #pharmacybenefits so employers can continue to offer, sustainable, affordable benefits.

Optimizing Oncological Care: The Influence of AI on Insurance Approvals: Successful integration demands overcoming various hurdles. #finance #pharmacy #lifesciences