Paul L. Jeffrey, PharmD, discusses different contracting strategies that can help improve patient access to prescription digital therapeutics (PDTs) in this #PeerExchange from AJMC - The American Journal of Managed Care. Watch as experts discuss the future of PDTs here: https://bit.ly/4enc60s #PDT
AJMC - The American Journal of Managed Care
Book and Periodical Publishing
Cranbury, New Jersey 5,146 followers
About us
The American Journal of Managed Care® is a peer-reviewed publication dedicated to disseminating clinical information to health care professionals, aiming to foster scientific communication in managed care. It covers diverse issues in clinical decision-making and evaluates the impact of interventions on health care and economic outcomes.
- Website
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http://www.ajmc.com/
External link for AJMC - The American Journal of Managed Care
- Industry
- Book and Periodical Publishing
- Company size
- 11-50 employees
- Headquarters
- Cranbury, New Jersey
- Type
- Privately Held
- Specialties
- Managed Markets, The American Journal of Accountable Care, Live Events , Market Research, Custom Publishing, KOL Engangement, Account Manager Training and Tool Development, AJMC: Evidence-Based Oncology, and AJMC: Evidence-Based Diabetes Management
Locations
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Primary
2 Clarke Drive
Suite 100
Cranbury, New Jersey 08512, US
Employees at AJMC - The American Journal of Managed Care
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Sachin H. Jain, MD, MBA
Sachin H. Jain, MD, MBA is an Influencer President and CEO, SCAN Group & Health Plan
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Benjamin Baruch
Helping pharmaceutical manufacturers reach and educate their market access customers
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James Roskowinski
National Account Manager for The American Journal of Managed Care
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Alexander Alvarnas
Pre-Law Public Health Major
Updates
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Change is on the horizon. Something big is coming to the world of health care publications. Stay tuned for a transformation that will redefine the conversation. #HealthcareEvolution #ComingSoon
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A recent report by The Commonwealth Fund has highlighted a pervasive issue in the US health care system: medical billing errors and coverage denials. Over the past year, 45% of insured adults received unexpected medical bills for services they believed were covered. Even more concerning, 17% of doctor-recommended services were denied coverage. 🩺 Impact on Health and Well-Being This discrepancy not only strains finances but also worsens health outcomes. Among 7800 surveyed insured adults, 60% faced care delays due to coverage denials, and 47% reported deteriorating health as a result. The emotional toll is significant, with 80% experiencing worry and anxiety. 💸 Rising Costs and Expenditures Despite a peak in insurance coverage at 93.1%, national health expenditures soared to $4.8 trillion last year and are projected to reach $7.7 trillion by 2032. Chronic and mental health conditions account for 90% of this spending. 🚨 Insurance Tactics and Swift Denials Investigations reveal insurers' aggressive denial tactics, often rejecting claims without thorough review. For instance, Cigna's PXDX system denied 300,000 requests in just 2 months, spending an average of 1.2 seconds per case. 📊 Consumer Awareness and Appeals Alarmingly, only 43% of adults appealed denied claims, with 54% unsure of their rights. This knowledge gap is especially prevalent among low-income individuals and younger adults. 🛡️ Calls for Reform and Accountability The need for transparency and accountability is urgent. Federal and state policymakers, regulators, and insurers must work together to enhance consumer awareness and ensure fair practices. #Healthcare #Insurance #MedicalBilling #CoverageDenials #PatientRights #HealthOutcomes #PolicyReform Read more!
Survey Exposes Pervasive Billing Errors, Aggressive Tactics in US Health Insurance
ajmc.com
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A recent National Pharmaceutical Council survey of 110 employer drug benefit decision-makers provides insights into rebate arrangements for specialty drugs, the role of benefits brokers and consultants, and the importance of rebate-related factors in selecting a pharmacy benefits manager (PBM). Rebate Agreements: Nearly two-thirds (62.7%) of employers have rebate agreements with a rebate guarantee for specialty drugs. Influential Decision Makers: Benefits consultants (37.3%), HR/benefits leaders (29.1%), and benefits brokers (21.8%) are the most influential in shaping rebate strategies. Importance of Rebate Guarantees: Employers with rebate guarantees place a higher importance on these guarantees when selecting a PBM (median importance score of 9) compared to those without guarantees (score of 7) or those not receiving rebates (score of 7.5) (P = .001). These findings highlight the critical role of rebate guarantees and the significant influence of benefits consultants and brokers in PBM selection. As the conversation around PBMs and drug rebates continues, it's essential to recognize the impact of employer benefits consultants in maintaining reliance on guaranteed rebate arrangements. Read more! #Healthcare #PharmacyBenefits #PBMs #SpecialtyDrugs #Rebates #EmployeeBenefits
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Last night's IVBM event in Columbus, Ohio, was amazing! Thank you to our partner organization, Ohio State University Comprehensive Cancer Center-James Cancer Hospital & Solove Research Institute, for hosting a night filled with insightful perspectives and networking. Check out our upcoming events here: www.ajmc.com/ivbmevents. #ManagedCare #ValueBasedCare #Oncology
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🎬 Ever wonder how programming for PCOC develops? Check out this behind-the-scenes interview to learn more! #BehindTheScenes #PCOC2024 Register here: https://bit.ly/3zFRAbL
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Joyce O’Shaughnessy, MD, examines the primary differences in the toxicity profiles of abemaciclib and ribociclib, offering insights into selecting CDK4/6 inhibitors for use with high-risk early breast cancer. Watch the #PeerExchange here: https://bit.ly/3WLJ7g9. #BreastCancer
Primary Differences in the Toxicity Profiles of Abemaciclib and Ribociclib
ajmc.com
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Pharmacy benefit managers (PBMs) have been intermediaries in the US health care system since the 1960s, with their roles evolving significantly. Recently, PBMs have faced increased scrutiny for their lack of transparency and their impact on drug costs and access. In July, the FTC released a 71-page interim report based on a 2022 investigation into PBM practices, revealing significant impacts on the health care delivery system and patients. Here are 5 key takeaways from the report: 1. Role Evolution: While PBMs continue to negotiate drug prices and manage drug formularies, their integration into the pharmaceutical supply chain has drawn federal antitrust scrutiny. Today, the 3 largest PBMs manage 79% of US prescription drug claims. 2. Price Negotiation: PBMs aim to lower drug costs through negotiations, but savings often don't reach patients. A House Committee report found that PBMs inflate drug costs using unclear pricing and utilization schemes. 3. Formulary Development: PBMs develop formularies that dictate drug coverage. Investigations reveal that PBMs favor drugs with higher rebates, resulting in higher out-of-pocket costs for patients, especially for expensive medications like cancer treatments. 4. Preferred Pharmacy Networks: PBMs' consolidation allows them to steer prescriptions to affiliated pharmacies, squeezing out independent businesses. This reduces competition and impacts patient access to local pharmacies, especially in rural areas. 5. Lack of Transparency: The opaque nature of PBM practices hinders efforts to fully understand their impact on drug pricing and access. Recent findings show that PBMs are creating foreign corporations, likely to evade proposed reforms and transparency requirements. Addressing these issues is crucial for improving drug pricing and patient access in the US health care system. Read more! #Healthcare #Pharmacy #PBMs #DrugPricing #FTC #Transparency
5 Things to Know About PBMs’ Influence on Drug Costs and Access
ajmc.com
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Dive into The Evidence Based Oncology® July issue for a must-read feature on the annual ASCO (American Society of Clinical Oncology) recap issue. Don’t miss out—read now! https://bit.ly/3WsodRU
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Ahead of this year's American Society for Preventive Cardiology (ASPC) meeting on August 2-4 in Salt Lake City, Utah, we spoke with ASPC President-Elect Michael Shapiro about the upcoming conference. #ASPC2024 #Cardiology #CVD #Prevention Watch now!
ASPC Congress to Highlight Innovations in CVD Prevention
ajmc.com