The long and short of the OptumRX agreement is to allow patients to be able to pick up and fill a prescription in a retail store versus mail order. That in inself tells me that there’s folks who don’t care for mail order services? In addition, Walgreens wi…
Continue ReadingYou can read the CMS Sanctions Cigna-No More Selling Any New Medicare Advantage Policies Until Algo Problems Denying Medical Coverage and Prescription Denials Are Fixed United Healthcare Having a Big Bond Sale to Finance Purchase of Catamaran Pharmacy Benefi…
Continue ReadingSo let’s get down to what’s really happening here. Once upon a time the PBM models were a different type of creature but as time moved on they became less about a better and affordable price for prescriptions and more about and algorithmic machine to create …
Continue ReadingThis is a good story right here about Advair. As mentioned the drug company recovered their R and D cost a long time ago, so what do they do next, patent the inhaler for a longer coverage time, since the drug itself is off patent. For a 3 month supply the …
Continue ReadingEveryone now has made the big change to convert from ICD9 to ICD10 Coding for medical billing. When all of this was taking place, many said it would really not improve care and so far, that’s what we have seen. The big coding change has not any impact in th…
Continue ReadingYou know they are going to use these flawed medication adherence scores to determine who gets what with medications. This is horrifically flawed. Regulation won’t work and CMS should work towards getting lower drug prices instead of this model that comes ba…
Continue ReadingFirst question out of the barrel might be “how can that be”. It’s really not too difficult to figure out. A short while back United Healthcare bought a pharmacy benefit manager named Catamaran, and actually took on $10 billion in debt to acquire them. This…
Continue ReadingHow many companies used the Ingenix Data Base one has to question. While current Ingenix had a name change to Optum Insights a couple years ago and I think all the lawsuits might have had something to do with that. Another United Healthcare (Ingenix) Laws…
Continue ReadingHere we go again, back to those Ingenix algorithms and business models, getting a rerun of sorts of what occurred in 2011. In 2011 there was one main lawsuit from the AMA along with many others that were filed (some being still settled) over using formulas t…
Continue ReadingPatients Who Pay “Cash” When Filling Prescriptions Are Now Called “Outliers, Pharmacists Required to Fix Outliers as They Show Up As Non Medication Adherence Compliant With 5 Star Systems Full of Flawed Data… Do you not think these flawed scores will be used…
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