Defining Formularies & Step Therapy Medications
2 MIN READ
HealthCare.gov defines a formulary as, a list of prescription drugs covered by a prescription drug plan offering prescription drug benefits. Typically, a “prior authorization” for coverage is needed when a medication is not listed on the formulary or requires step therapy. Management of the formulary is often maintained by a pharmacy benefit manager (PBM), such as First Script. Meaning, when a medication is not on a formulary, First Script would start the prior authorization process to get approval for payment of the medication.
How Managing Provider Data Can Make a Positive Impact on the Claims Process
As we’ve established in the first two articles in this series, provider data quality is an issue in the Property and Casualty industry that can be challenging to manage and maintain. Though it can be difficult, provider data management is a worthwhile project, since accurate provider data helps facilitate data-driven decision making, which can in-turn lead to improved efficiencies and outcomes for claims organizations.
Five Guidelines for Provider Data Management
The majority of healthcare provider data today is fraught with inaccurate or duplicate information, causing a multitude of issues for claims organizations, notably workflow inefficiencies and suboptimal outcomes. An accurate provider database can help to improve efficiencies, but managing provider information is more difficult than it may seem on the surface.
WorkCompWire: Shore Up the Home Health Staffing Shortage with a Deep Bench of Expertise
Explore how Bob Smith addresses the growing home health staffing shortage in workers' compensation by leveraging a nationwide network of skilled caregivers to ensure consistent, high-quality care for injured employees.
WorkCompWire: How Outdated Imaging Equipment is Impacting Quality of Care and Claim Costs
Ted Smith discusses how outdated diagnostic imaging equipment affects care quality and drives up workers’ compensation claim costs—highlighting the importance of modern technology in improving outcomes and reducing inefficiencies
Guidewire Connections 2019
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The Difference Between Specialty Drugs, Biologics, and Biosimilars
3 MIN READ
In the world of workers’ comp pharmacy benefit management, understanding generics vs. brand name drugs, narcotics, muscle relaxants, and compounds now seems relatively simple as compared with the latest pharmacy terminology: specialty drugs, biologics, and biosimilars. These terms are making the headlines with increased frequency, and while some think they are interchangeable, there truly are distinctions between them.