International Sourcing: What To Consider

International Sourcing: What To Consider International Sourcing is a Potential Solution to Managing High Prescription Drug Costs with Questionable Longevity The Issue at a Glance Americans seeking relief from the high costs of prescription drugs have looked to importation as an attractive, politically popular option for years. Congress and federal regulators at the U.S. Food…

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Maximum Fair Price and Implications for Payers

Maximum Fair Price and Implications for Payers The Lynchpin of Medicare Price Negotiations under the Inflation Reduction Act (IRA) The Issue at a Glance Maximum fair price (MFP) serves as the foundation of Medicare’s drug price negotiation program. It is the highest price that a Medicare Part D plan sponsor or beneficiary can pay for…

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Specialty Pharmacy Network Disruptors

Specialty Pharmacy Network Disruptors New entrants bring alternatives to standard Pharmacy Benefit Manager networks What is a specialty pharmacy network? Let’s lay some groundwork before we go into “What’s New.” Specialty medications are more than half of the cost of medication spend, and payers are constantly looking for methods to ‘bend the trend,’ control costs,…

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Understanding the future of Copay Maximizers

Understanding the future of Copay Maximizers COPAY MAXIMIZERS – Gone tomorrow? What is a Copay Maximizer? Copay Maximizers are programs deployed by Pharmacy Benefit Managers (PBMs) that allow a payer to capture the pharmaceutical manufacturers’ funding that is designated to offset patient copays and further offset payer costs. This is done by applying the funding…

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Medicare Prescription Payment Plan

Medicare Prescription Payment Plan What is Copay Smoothing and How can Part D Plan Sponsors Prepare? Issue at a Glance Thanks to the Inflation Reduction Act (IRA), the Medicare Part D benefit will undergo a major redesign in 2025. As part of this, all plan sponsors will be required to offer all beneficiaries the Medicare…

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