Medical or Pharmacy Benefit

Medical or Pharmacy Benefit A white paper on the background of pharmacy vs medical coverage Managing drug spend on both benefits With the pipeline of medications and treatments being largely ultra-expensive medications overwhelmingly infused, injected or through more expansive treatment protocols like gene therapies – decisioning on where to cover these medications is now, more…

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Covid Testing – Does Free Equal Frivolous?

Covid Testing – Does Free Equal Frivolous? A white paper concerns of waste, and coverage change What is Changing, and When? The requirement by the federal government for commercial coverage of COVID-19 tests ends May 11, 2023. While some have stated concern over a potential inability to get the testing once it is no longer…

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Sanofi Joins Lilly and Novo Nordisk to Cut Insulin Prices (Update)

Sanofi Joins Lilly and Novo Nordisk to Cut Insulin Prices (Update) A white paper on what this means to medication cost management What is the Update? Following suit of Lilly and Novo Nordisk, Sanofi announced price decreases and caps on their insulin products that would take effect at the beginning of next year. Price decreases…

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Network Audit – Results vs Remedies

Network Audit – Results vs Remedies A white paper on pharmacy audit & investigations Understanding your audit and investigative program – is it working for you? In many cases, we see our audit and investigative reports and check a box that our vendors are managing the network and preventing Fraud, Waste, and Abuse (FWA). Running…

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Lilly and Novo Nordisk to cut insulin Prices

Lilly and Novo Nordisk to cut insulin Prices A white paper on what this means to medication cost management What was the change? Both Lilly and Novo Nordisk have announced that their companies will reduce the price of several branded insulin products by as much as 75%. Novo’s decision on March 14th followed closely after Eli…

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Manufacturer Funding Changes & Challenges

Manufacturer Funding Changes & Challenges A white paper on the opposing thoughts on patient assistance What is happening in the world of manufacturer funding assistance? We previously wrote a white paper on the ups and downs of manufacturer funding assistance – read that article on our Industy Insights section of PayerAlly.com. Now, we are taking…

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Gene Therapy – “Therapy” Not Medication

Gene Therapy – “Therapy” Not Medication A white paper on understanding gene therapy What is Gene Therapy? Gene therapy is all the BUZZ in conversations about medication cost control and yet it is not a medication. So what is gene therapy and what makes it different than the ‘medications’ of the past. Why should we…

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Manufacturer Funding – The Ups & Downs

Manufacturer Funding – The Ups & Downs A white paper on manufacturer funding Why is manufacturer subsidized funding a ‘big deal’? There has been a great deal of commentary on manufacturer funding, and how plans are using the funding to do more to offset patient cost share amounts. In this white paper, we are going…

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The Ins and Outs of PBM Audit

The Ins and Outs of PBM Audit A white paper on pharmacy audit & investigations Understanding your audit and investigative program – is it working for you? In many cases, we see our audit and investigative reports and check a box that our vendors are managing the network and preventing Fraud, Waste, and Abuse (FWA).…

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Administrative Fees or Percent of Value

Administrative Fees or Percent of Value A brief discussion on paying for medication management services Do Vendor Payment Models Support a Drive to Lowest Net Cost? In many cases, we see our audit and investigative reports and check a box that our vendors are managing the network and preventing Fraud, Waste, and Abuse (FWA). Running…

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