blue connect dots

Tag: unified medication management

blue connect dots

October 4, 2023

Rebates, Discounts, and Formularies: How PBMs Shape Medication Access & the Benefits of Automating Prior Authorizations for Pharma and Medical Benefits

by Susan Lawson-Dawson | Healthcare Technology, Prior Authorization

As professionals deeply involved in patient care, understanding the complex dynamics of medication access represents a pivotal aspect of your role. Prescription medications are often the cornerstone of treating numerous health conditions, but how these medications are priced, accessed, and distributed can be enigmatic, to say the least. Some medications fall under medical benefits, such as injection or infusions of biologics for rheumatoid arthritis. Others, those self-administered by the patient, fall under pharmacy benefits.  That’s where Pharmacy Benefit Managers (PBMs) enter the picture. This adds yet another layer to the already complicated world of prior authorizations, which often serves as… Read entire article here

October 4, 2023

Why the Evolving Role of Pharmacy Benefit Managers Increases the Need for Automated Prior Authorization

by Susan Lawson-Dawson | Healthcare Technology, Prior Authorization

Pharmacy Benefit Managers (PBMs) originated during the 1960s in response to the growing complexity of drug benefit programs within health insurance plans. Initially, PBMs’ primary role was to process prescriptions and handle the administrative burden for insurers. As the healthcare landscape evolved, so too did the responsibilities of PBMs, expanding to include drug formulary management, pharmacy network contracting, and drug utilization reviews. And of course, PBMs began using prior authorization to further manage costs. Is it any wonder that providers want a way to automate prior authorizations to relieve the administrative burden?  That's where a prior authorization platform offering unified… Read entire article here