Lynn Giudice’s Post

Exploring the Ins and Outs of Buy-and-Bill: A Deep Dive into Provider-Administered Drugs. Our latest blog covers everything from the basics to best practices, offering valuable insights for healthcare providers and payers alike: https://lnkd.in/eE-_8_r4 #Healthcare #BuyAndBill #SpecialtyDrugs #PACS

340B can be a powerful tool for healthcare equity by creating a ripple effect where drug savings for safety-net providers translate into expanded services and healthier communities. As technology to manage drug discounts bridges the gap between 340B and even MDRP, a more streamlined system could be effective in unlocking the program's full potential, allowing cost savings to flow directly to patients and fuel further progress in affordable care. #340B #Healthcare #MDRP

Two pharmaceutical giants, Pfizer and Eli Lilly and Company, have launched innovative direct-to-consumer platforms aimed at revolutionizing patient care. PfizerForAll is Pfizer’s new multi-pronged service offering telehealth appointments, home delivery prescription services, vaccination scheduling, and savings programs. This platform is designed to simplify healthcare access, making it easier for patients to manage their health needs from the comfort of their homes. PfizerForAll is changing the game and streamlining the healthcare experience for many consumers. By partnering with UpScriptHealth, Zocdoc, Alto Pharmacy and Instacart, Pfizer is not just providing medicine but a seamless, supportive healthcare experience that includes financial assistance, insurance co-pay guidance, and affordability programs. On the other hand, LillyDirect by Eli Lilly and Company focuses on providing Telehealth services for conditions like obesity, diabetes, and migraines. LillyDirect offers patients more choices in how, when and where they access healthcare. Providing the support they need without having to navigate complex healthcare systems. Both platforms are a testament to how the healthcare industry is evolving to meet the needs of patients in a more direct and accessible manner. #DigitalHealth #HealthcareInnovation #Telehealth #Pharma #Healthcare #HomeHealth

Healthcare cost trend projected 8% in 2025, the increase over 5% yearly for a while, driven by inflationary pressure, prescription drug spending and behavioral health utilization, according to a report from the PwC Health Research Institute. For example, a 5% trend means that a plan that costs $10,000 per member in 2024 would cost $10,500 in 2025. The medical cost trend, or growth rate, is primarily influenced by changes in the price of medical products and services and prescription medications, known as unit cost inflation, and changes in the number or intensity of services used or changes in per capita utilization.

CMS Tackles Generic Drug Costs. The Centers for Medicare & Medicaid Services (CMS) has introduced a proposed list of generic drugs aimed at reducing cost-sharing burdens for patients. This initiative could significantly lower the out-of-pocket costs for essential medications. Key takeaways:  💠Reduced costs for essential generics  💠Potential positive impact on patient care    💠More equitable access to critical medications Want to know more about how this proposal could change healthcare? Check out the full article: https://lnkd.in/eEu8qwHJ #generics #Healthcare  #medicare #medicine #pharma

Anytime you add a middle man to your plan, you add costs. Payers, what if your pharmacy charged per patient, and all costs were 100% transparent? Patients, what if you didn't have to worry about how much your medications would cost from one month to the next...because they came at no cost to you? Let's talk about adding HaloScrips to your plan next year. Plans AND patients save money. (And they really like working with us, too!) #pharmacy #goodrx #prescriptions #PBMs #healthplans #prescriptioncoverage #prescriptioncosts #healthcare https://lnkd.in/eyAUEhBt

This article does make some valid points about 340B, but there are many things it fails to consider. ❌ Myth: Patients don't benefit from 340B discounts. ✅ Fact: While there's room for improvement in accessibility, countless patients rely on the reduced prices facilitated by 340B to access essential medications. These discounts DO make a tangible difference in affordability for many. ❌ Myth: Contract pharmacies aren't integral to the program. ✅ Fact: The evolution of contract pharmacies has expanded access to 340B medications, particularly in underserved areas. This growth represents progress in reaching those who need assistance the most to ensure no one is left behind. ❌ Myth: Transparency is lacking in 340B transactions. ✅ Fact: Efforts to enhance transparency are ongoing, but let's not overlook the core mission of 340B: to support healthcare providers serving vulnerable populations. The 340B program has made strides in expanding access to vital medications and healthcare services. There's always room for improvement, but let's not lose sight of the countless lives positively impacted by this essential initiative. #340B #Healthcare #Medications

In his new Forefront article, James Robinson of the University of California, Berkeley argues that high hospital mark-ups on infused drugs create socially undesirable impacts on the health care system, reducing financial support for innovation and increasing market consolidation, supply chain complexity, and consumer cost sharing. "Insurers have developed two strategies to limit drug price markups by hospitals. The first eliminates the “buy and bill” structure by creating insurer-owned specialty pharmacies, which distribute physician-administered drugs while retaining insurer ownership. The second discourages patients from obtaining infusions in hospital clinics in favor of community-based physician offices or home infusion programs. This is implemented by imposing higher cost sharing for patients using hospital clinics or by refusing to reimburse hospital clinics altogether." Read the full article here: https://bit.ly/3T2EL1d

With healthcare landscapes constantly evolving, understanding the latest CMS requirements for Medication Therapy Management (MTM) programs is crucial. This comprehensive guide by Clarest provides a roadmap for payers to stay compliant and ahead of the curve. Learn about key changes, strategic implementation tips, and best practices to ensure your MTM programs meet CMS expectations. Stay informed and make informed decisions for your healthcare programs. Click the link below. #Healthcare #CMS #MTM #Payers #Compliance

The Optum Rx announcement about their new model starting 1/1/25 is making the rounds on here. As PBMs develop new approaches, it is even more vital that self-funded employers, TPAs, Health plans, and brokers have a pharmacy benefit consultant on top of the changes and with the ability to compare PBMs despite the ever-growing variability! This is where the team at Innovative Rx Strategies comes in and ensure you can still find the right fit regardless of the ever-changing landscape! https://lnkd.in/gfEkUnuB #Pharmacists #Pharmacybenefits #PBM #dontjustspreadsheet!