You 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 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…
Continue ReadingThe 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 ReadingOne thing we all hate is the high prices we pay in the US today for our prescriptions. Sure we do get some discounts, but that too has become an effort in algorithmic shopping to click here and click there to get the best price. It shouldn’t have to be that…
Continue ReadingI had a conversation with a pharmacist who took some time to cue me in to what’s going on in the world of “Medication Compliance Predictions” and the impact it has on the life and job of a pharmacist. To tell you the truth, I was absolutely floored at how m…
Continue ReadingThis is just taking this a little too far and we know when you let Quants go wild, they will go, and go and go and quantitate and create spurious correlations and sell and market you on the fact they they have value and they do not. If you read around the we…
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 ReadingWhen you read this article entirely, it’s like what in the heck is this now? Seriously read the analytics that will be taking place and the company Anthem has contracted with of course is seeing some big dollar signs. Your medical records are up for review …
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 ReadingCentene is yet another managed care organization which you could say was a competitor of Health Net in some ways. The big pull here is becoming one of the largest if not the largest company managing Medicaid. Both boards have approved the merger/acquisition…
Continue ReadingI have been asked this question many times and with the war on both cost of drugs and the war on cash, I thought this might be helpful to put some links in as a reference. Granted all the drugs you need won’t be on the lists perhaps, but there’s enough of th…
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 ReadingThis should not really come as a big surprise as what hasn’t the pharmacy benefit managment business touched? So what is Patients Who Pay “Cash” When Filling Prescriptions Are Now Called “outliers, Pharmacists Required to Fix outliers as They Show Up As Non …
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 …
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