Managed Care Pharmacy Issues

Stay updated on the latest managed care pharmacy issues with our comprehensive resources. Explore key topics, current challenges, and expert insights to enhance your practice and advocate for better health care solutions. Learn more about our advocacy with our pharmacy practice positions.

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Prior Authorizations Play Crucial Role in Ensuring Appropriate Medication Use

AMCP CEO Blog: With PA so often misunderstood, perhaps we need to do a better job of explaining this tool to the general public. For example, we might provide an example of how PAs are applied to opioids as additional safeguards to ensure their appropriate use. Or how a PA might be applied to botulinum toxin to ensure the prescription is for medical, rather than cosmetic, purposes.
Prior Authorization/Electronic Prior Authorization (ePA), Managed Care Practice Issues

Population Health Management

Population health management (PHM) is a key concept in managed care. Improving population health, enhancing the patient experience, and reducing per capita cost are the primary goals of a philosophy called the Triple Aim. PHM extends beyond healthcare organizations, requiring the cooperation of other types of institutions, such as public health departments and social service entities.
Formulary & Utilization Management, Managed Care Practice Issues

Outcomes Research

The purpose of outcomes research per the Patient Centered Outcomes Research Institute (PCORI) is to assist patients, clinicians, purchasers and policy makers in making informed health decisions by advancing quality and relevance of evidence. The Agency for Healthcare Research and Quality (AHRQ) defines the purpose of outcomes research as a tool to provide evidence about benefits, risks, and results of treatments so clinicians and patients can make more informed decisions.
Managed Care Practice Issues

Disease Management

Disease management is the concept of reducing health care costs and improving quality of life for individuals with chronic conditions by preventing or minimizing the effects of the disease through integrated care. Disease management programs are designed to improve the health of persons with chronic conditions and reduce associated costs from avoidable complications by identifying and treating chronic conditions more quickly and more effectively, thus slowing the progression of those diseases.
Rare Diseases, Specialty Tiers, Managed Care Practice Issues, Specialty Pharmacy, Specialty Tiers