specialty pharmacy

How often do health plans use “provider requirements”?

Specialty drugs have delivered significant improvements to patient health, but oftentimes they pay be expensive. To try to insure that these treatments are used appropriately, some health plans impose a utilization management tool known as “prescriber requirements” where only certain types of physicians may prescribe a drug. While this may be useful for some complex …

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Integrated Delivery Network-based Specialty Pharmacies

Increasingly, integrated delivery networks (IDNs) are creating their own full-blown specialty pharmacies. Many are familiar with the integrated payer-provider model from groups such as Kaiser Permanente. However, other IDNs are getting into the game according to a recent white paper. Why are IDNs considering creating their own specialty pharmacies? Address patient access concerns. The number …

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Health systems bringing specialty pharmacy in-house

That is one trend as reported in Modern Healthcare. Being able to better managed health care spend across medical and pharmacy is one reason. In 2018 alone, about 76% of hospitals with over 600 beds operated a specialty pharmacy, in comparison to a little under half in 2016, according to American Society of Hospital Pharmacists. Growth in …

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Why hospitals want CMS, FTC to examine two UnitedHealthcare policies

Two UnitedHealthcare policies have raised several concerns among providers, including that they may display anti-competitive behavior and could block patient access to certain healthcare services. The American Hospital Association is asking the FTC and CMS to review and potentially block these policies.

Spending on specialty drugs: 2010-2017

Specialty drugs are often injectibles, biologic drugs, or other drugs that require specialized administration, handling, or ongoing clinical assessment. Specialty drugs are often more expensive than standard pharmaceuticals. As the use of specialty pharmaceuticals has become more common, a paper by Hill, Miller and Ding (2020) aims to quantify how much spending on specialty pharmaceuticals …

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