utilization management

Inefficient payer approval processes fail patients, frustrate docs“Preauthorization has escalated beyond reason,” according to AACU President Charles McWilliams, MD.
Payers to pharma: Here’s what we’re missing in hep C drugsA Precision for Value survey highlights what can be done in order to encourage payers to ease coverage policies for these drugs in the next wave of HCV treatment.
How state-mandated formularies impact costsResearch by Express Scripts presented at the AMCP examines costs among Medicaid members in the Florida plan to members in a similar Medicaid plan without a state-mandated formulary.
Six ways to combat pharma price gougingDrug price increases can prove challenging for payers. Here’s six strategies to keep in your arsenal.
Five ways to contain the specialty drug spendThe high cost of specialty medications requires an array of management techniques, according to a recent presentation at the Academy of Managed Care Pharmacy Nexus 2015. Read more.
Prior auths are here to stayWe asked healthcare experts and analysts how the move to value-based care will affect prior authorizations. Here's what they said.
Users struggle to move dataInteroperability remains a serious challenge
Need for utilization management growsNew utilization management opportunities will increasingly include cardiology and diagnosis of sleep disorders
State of the Industry: Health StatusYoung invincibles who are used to their parents' plans will no doubt want to continue coverage
Utilization management programs may increase appropriate use of medication and quality of healthcarePrime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. The company is headquartered in St. Paul, Minn., and manages pharmacy benefits for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and delivers medicine to nearly 20 million members, offering clinical services for people with complex medical conditions. Prime is collectively owned by 13 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans.