Download or read book Understanding Pharmacy Reimbursement written by F. Randy Vogenberg and published by ASHP. This book was released on 2006 with total page 169 pages. Available in PDF, EPUB and Kindle. Book excerpt: As a health system pharmacist dealing with health care reform initiatives and accountable care organizations, it is important to have a fundamental understanding of health care reimbursement that has a focus on pharmacy. Understanding Pharmacy Reimbursement is the essential resource that allows you to more effectively deal with the rapidly changing and constantly emerging reimbursement issues over the next few years.
Download or read book Understanding Pharmacy Reimbursement written by American Society of Health-System Pharmacists and published by . This book was released on 2014-05-14 with total page 169 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book PBMs written by Sheila Shulman and published by CRC Press. This book was released on 1998-06-18 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt: PBMs: Reshaping the Pharmaceutical Distribution Network provides HMOs and other third-party payers with information on the new and increasingly important role of pharmaceutical benefit companies (PBMs) in the health care industry. From this text, you will learn how PBMs can maintain and deliver a quality, cost-effective drug benefit plan to your company while achieving the anticipated market share for the product. PBMs: Reshaping the Pharmaceutical Distribution Network offers you suggestions on how to choose which PBM service is correct for your business, such as what qualifications to look for in a PBM, as well as what questions you should ask a respective company. This text also offers ways on how your company can benefit from becoming a client and may make your business more competitive in the pharmaceutical industry. PBMs: Reshaping the Pharmaceutical Distribution Network also informs you about the controversies that have arisen concerning the new position of PBMs in the industry. Through research and evaluation, this text addresses these issues from many different perspectives and gives you insight into other topics concerning PBMs, including: operating methods that PBMs currently rely on for designing and overseeing a drug benefit plan how the Food and Drug Administration currently views the role of PBMs and why they are contemplating regulatory intervention alerting PBMs, pharmacies, pharmaceutical companies, and managed care organizations to new legal issues involving fraud and abuse affecting pharmacy benefit management and pharmaceutical manufacturers reasons why retail drug chains and pharmacist organizations oppose recent industry developments regarding PBMs whether or not PBMs reflect a move toward greater centralized decisionmaking in the health care systemIn addition, PBMs: Reshaping the Pharmaceutical Distribution Network offers pharmaceutical companies, health care providers, and managed care organizations several suggestions for further research, which may make your business or your business relationships more efficient and productive in the future. If you or your company are considering the services of a pharmacy benefit management, PBMs: Reshaping the Pharmaceutical Distribution Network will guide you in choosing a company that helps you deliver the most cost-effective and efficient pharmaceutical benefits to customers.
Download or read book Making Medicines Affordable written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2018-03-01 with total page 235 pages. Available in PDF, EPUB and Kindle. Book excerpt: Thanks to remarkable advances in modern health care attributable to science, engineering, and medicine, it is now possible to cure or manage illnesses that were long deemed untreatable. At the same time, however, the United States is facing the vexing challenge of a seemingly uncontrolled rise in the cost of health care. Total medical expenditures are rapidly approaching 20 percent of the gross domestic product and are crowding out other priorities of national importance. The use of increasingly expensive prescription drugs is a significant part of this problem, making the cost of biopharmaceuticals a serious national concern with broad political implications. Especially with the highly visible and very large price increases for prescription drugs that have occurred in recent years, finding a way to make prescription medicinesâ€"and health care at largeâ€"more affordable for everyone has become a socioeconomic imperative. Affordability is a complex function of factors, including not just the prices of the drugs themselves, but also the details of an individual's insurance coverage and the number of medical conditions that an individual or family confronts. Therefore, any solution to the affordability issue will require considering all of these factors together. The current high and increasing costs of prescription drugsâ€"coupled with the broader trends in overall health care costsâ€"is unsustainable to society as a whole. Making Medicines Affordable examines patient access to affordable and effective therapies, with emphasis on drug pricing, inflation in the cost of drugs, and insurance design. This report explores structural and policy factors influencing drug pricing, drug access programs, the emerging role of comparative effectiveness assessments in payment policies, changing finances of medical practice with regard to drug costs and reimbursement, and measures to prevent drug shortages and foster continued innovation in drug development. It makes recommendations for policy actions that could address drug price trends, improve patient access to affordable and effective treatments, and encourage innovations that address significant needs in health care.
Download or read book The Changing Economics of Medical Technology written by Institute of Medicine and published by National Academies Press. This book was released on 1991-02-01 with total page 225 pages. Available in PDF, EPUB and Kindle. Book excerpt: Americans praise medical technology for saving lives and improving health. Yet, new technology is often cited as a key factor in skyrocketing medical costs. This volume, second in the Medical Innovation at the Crossroads series, examines how economic incentives for innovation are changing and what that means for the future of health care. Up-to-date with a wide variety of examples and case studies, this book explores how payment, patent, and regulatory policiesâ€"as well as the involvement of numerous government agenciesâ€"affect the introduction and use of new pharmaceuticals, medical devices, and surgical procedures. The volume also includes detailed comparisons of policies and patterns of technological innovation in Western Europe and Japan. This fact-filled and practical book will be of interest to economists, policymakers, health administrators, health care practitioners, and the concerned public.
Download or read book Rare Diseases and Orphan Products written by Institute of Medicine and published by National Academies Press. This book was released on 2011-04-03 with total page 442 pages. Available in PDF, EPUB and Kindle. Book excerpt: Rare diseases collectively affect millions of Americans of all ages, but developing drugs and medical devices to prevent, diagnose, and treat these conditions is challenging. The Institute of Medicine (IOM) recommends implementing an integrated national strategy to promote rare diseases research and product development.
Download or read book Medicaid written by United States. General Accounting Office and published by . This book was released on 1993 with total page 24 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Pharmacy Technician Certification Exam Ptce written by National Learning Corporation and published by Admission Test. This book was released on 2019 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Admission Test Series prepares students for entrance examinations into college, graduate and professional school as well as candidates for professional certification and licensure. The Pharmacy Technician Certification Exam (PTCE) Passbook(R) prepares you by sharpening the skills and abilities necessary to succeed on your upcoming entrance exam. It provides hundreds of questions and answers in the areas that will likely be covered on your upcoming exam, including but not limited to: pharmacy law and regulations; medication safety; inventory management; quality assurance; pharmacology; and more.
Download or read book Managed Care Pharmacy written by Albert I. Wertheimer and published by CRC Press. This book was released on 1999-02 with total page 434 pages. Available in PDF, EPUB and Kindle. Book excerpt: Position your company to keep pace in the changing environment of Managed Care! Managed Care Pharmacy: Principles and Practice analyzes trends in pharmacy benefit systems to provide physicians, pharmacists, payers, benefit consultants, and pharmaceutical companies with ways to preserve quality pharmaceutical care while reducing costs. Each chapter, written by an expert in the field, offers proven suggestions that will help you choose or develop a pharmacy benefit system that will maximize the goals of managed care organizations, pharmacists, and consumers. Discussing the importance of evaluating the success and cost-effectiveness of pharmacy benefit policies, this book gives you examples for creating and organizing monthly reports that will reveal how money is being spent or saved and if consumers are satisfied. Managed Care Pharmacy uses data and strategies that will help you understand and implement pharmacy benefits, enabling you to: examine past health care strategies--both successful and unsuccessful--to understand present changes increase pharmacist involvement in health plans by offering capital contracts as rewards evaluate models of money flow for pharmacy reimbursements choose between staff-model pharmacies, community (retail) pharmacies, and types of pharmacy networks to cut costs and increase customer satisfaction use the financial status of the benefit program, clinical outcomes reporting, prescription claims, and forms of electronic data interchange (EDI) to evaluate the cost-effectiveness and quality of care of various pharmacy systems Combining present knowledge and future implications, this book gives you insight and information into several different aspects of pharmacy benefits. This allows you to understand how important your role is in this area of health care. Complete with a glossary of managed care terms and formats for sample monthly reports and plan enrollment forms, Managed Care Pharmacy will help you work towards providing better, less costly pharmacy benefits for consumers and health care professionals.
Download or read book Pharmacy Benefits written by F. Randy Vogenberg and published by International Foundation of Employee benefit. This book was released on 2011 with total page 180 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pharmaceuticals have become an integral component of medical treatment, with some medications completely transforming health care outcomes and delivery. Drug therapy has been proven to reduce health care costs, increase productivity and enhance the quality of life for many people. When was the last time you examined the prescription drug component of your health care benefits? This primer offers factors to consider when designing or modifying pharmacy benefits, including the pros and cons of carving benefits into a health plan as well as carving them out as a separate prescription drug plan. A practical checklist is provided in almost every chapter to help you focus on important issues, including what questions to ask potential vendors.
Download or read book Report to the President written by and published by . This book was released on 2000 with total page 234 pages. Available in PDF, EPUB and Kindle. Book excerpt: On October 25,1999, the President directed the Secretary of Health and Human Services to study prescription drug costs and trends for Medicare beneficiaries. He asked that the study investigate: price differences for the most commonly used drugs for people with and without coverage; drug spending by people of various ages, as a percentage of income and of total health spending; and trends in drug expenditures by people of different ages, as a percentage of income and of total health spending. This report is the Department's response to that request. It represents the work of individuals and agencies throughout the Department, including the Agency for Healthcare Research and Quality (AHRQ), the Food and Drug Administration (FDA), the Health Care Financing Administration (HCFA), and the Office of the Assistant Secretary for Planning and Evaluation (ASPE).
Download or read book The Oxford Handbook of the Economics of the Biopharmaceutical Industry written by Patricia M. Danzon and published by Oxford University Press. This book was released on 2012-04-12 with total page 624 pages. Available in PDF, EPUB and Kindle. Book excerpt: The biopharmaceutical industry has been a major driver of technological change in health care, producing unprecedented benefits for patients, cost challenges for payers, and profits for shareholders. As consumers and companies benefit from access to new drugs, policymakers around the globe seek mechanisms to control prices and expenditures commensurate with value. More recently the 1990s productivity boom of new products has turned into a productivity bust, with fewer and more modest innovations, and flat or declining revenues for innovative firms as generics replace their former blockbuster products. This timely volume examines the economics of the biopharmaceutical industry, with eighteen chapters by leading academic health economists. Part one examines the economics of biopharmaceutical innovation including determinants of the costs and returns to new drug development; how capital markets finance R&D and how costs of financing the biopharmaceutical industry compare to financing costs for other industries; the effects of safety and efficacy regulation by the Food and Drug Administration (FDA) and of price and reimbursement regulation on incentives for innovation; and the role of patents and regulatory exclusivities. Part two examines the market for biopharmaceuticals with chapters on prices and reimbursement in the US, the EU, and other industrialized countries, and in developing countries. It looks at the optimal design of insurance for drugs and the effects of cost sharing on spending and on health outcomes; how to measure the value of pharmaceuticals using pharmacoeconomics, including theory, practical challenges, and policy issues; how to measure pharmaceutical price growth over time and recent evidence; empirical evidence on the value of pharmaceuticals in terms of health outcomes; promotion of pharmaceuticals to physicians and consumers; the economics of vaccines; and a review of the evidence on effects of mergers, acquisitions and alliances. Each chapter summarizes the latest insights from theory and recent empirical evidence, and outlines important unanswered questions and areas for future research. Based on solid economics, it is nevertheless written in terms accessible to the general reader. The book is thus recommended reading for academic economists and non-economists, and for those in industry and policy who wish to understand the economics of this fascinating industry.
Download or read book Extending Medicare Reimbursement in Clinical Trials written by Institute of Medicine and published by National Academies Press. This book was released on 2000-03-17 with total page 86 pages. Available in PDF, EPUB and Kindle. Book excerpt: Increasingly over the past five years, uncertainty about reimbursement for routine patient care has been suspected as contributing to problems enrolling people in clinical trials. Clinical trial investigators cannot guarantee that Medicare will pay for the care required, and they must disclose this uncertainty to potential participants during the informed consent process. Since Medicare does not routinely "preauthorize" care (as do many commercial insurers) the uncertainty cannot be dispelled in advance. Thus, patients considering whether to enter trials must assume that they may have to pay bills that Medicare rejects simply because they have enrolled in the trial. This report recommends an explicit policy for reimbursement of routine patient care costs in clinical trials. It further recommends that HCFA provide additional support for selected clinical trials, and that the government support the establishment of a national clinical trials registry. These policies (1) should assure that beneficiaries would not be denied coverage merely because they have volunteered to participate in a clinical trial; and (2) would not impose excessive administrative burdens on HCFA, its fiscal intermediaries and carriers, or investigators, providers, or participants in clinical trials. Explicit rules would have the added benefit of increasing the uniformity of reimbursement decisions made by Medicare fiscal intermediaries and carriers in different parts of the country. Greater uniformity would, in turn, decrease the uncertainty about reimbursement when providers and patients embark on a clinical trial.
Download or read book How Increased Competition from Generic Drugs Has Affected Prices and Returns in the Pharmaceutical Industry written by and published by U.S. Government Printing Office. This book was released on 1998 with total page 94 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medical Insurance Made Easy written by Jill L. Brown and published by Elsevier Health Sciences. This book was released on 2005-12-01 with total page 554 pages. Available in PDF, EPUB and Kindle. Book excerpt: This combination textbook and workbook, explains each phase of the medical claim cycle, from the time the patient calls for an appointment until the financial transaction for the encounter is completed. Coverage includes types of insurance payers, basic coding and billing rules, and standard requirements for outpatient billing using the CMS-1500 claim form. It also emphasizes legal aspects related to each level of the medical claim cycle and the importance of the medical office employee, showing their responsibility for and impact on successful reimbursement. 3 separate chapters offer coverage of the basic concepts of medical coding.A comprehensive overview of the CMS-1500 claim form with step-by-step guidelines and illustrations thoroughly covers reimbursement issues and explains the billing process.Includes detailed information on various insurance payers and plans including Medicare, government medical plans, disability plans, private indemnity plans, and managed care.Stop & Review sections illustrate how the concepts presented in each chapter relate to real-life billing situations.Sidebars and Examples highlight key concepts and information related to the core text lesson.A companion CD-ROM contains sample patient and insurance information that readers can use to practice completing the accompanying CMS-1500 claim form, as well as a demonstration of Altapoint practice management software. Features completely updated information that reflects the many changes in the insurance industry.Contains a new chapter on UB-92 insurance billing for hospitals and outpatient facilities.Includes a new appendix, Quick Guide to HIPAA for the Physician's Office, to provide a basic overview of the important HIPAA-related information necessary on the job.
Download or read book Pricing of Prescription Drugs written by Elizabeth R. Nesbitt and published by DIANE Publishing. This book was released on 2000 with total page 246 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book WHO guideline on country pharmaceutical pricing policies written by and published by World Health Organization. This book was released on 2020-09-29 with total page 70 pages. Available in PDF, EPUB and Kindle. Book excerpt: In recent years, high prices of pharmaceutical products have posed challenges in high- and low-income countries alike. In many instances, high prices of pharmaceutical products have led to significant financial hardship for individuals and negatively impacted on healthcare systems' ability to provide population-wide access to essential medicines. Pharmaceutical pricing policies need to be carefully planned, carried out, and regularly checked and revised according to changing conditions. Strong, well-thought-out policies can guide well-informed and balanced decisions to achieve affordable access to essential health products. This guideline replaces the 2015 WHO guideline on country pharmaceutical pricing policies, revised to reflect the growing body of literature since the last evidence review in 2010. This update also recognizes country experiences in managing the prices of pharmaceutical products.
