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Raulo S. Frear, PharmD, Says How PBMs Are Aligning Benefit Designs for Delivery System Reform
Raulo S. Frear, PharmD, general manager, OmedaRx, says pharmacy benefit managers are aligning benefit designs for delivery system reform in a few ways. With respect to the delivery system reform, if you look at ACOs as a specific example, our experience has been that the ACOs are not really ready to talk about different benefit designs, Dr Frear says. They're still learning what it means to accept risk and that means risk across a lot more areas than just pharmaceuticals.
Raulo S. Frear, PharmD, general manager, OmedaRx, says pharmacy benefit managers are aligning benefit designs for delivery system reform in a few ways.
“With respect to the delivery system reform, if you look at ACOs as a specific example, our experience has been that the ACOs are not really ready to talk about different benefit designs,” Dr Frear says. “They’re still learning what it means to accept risk and that means risk across a lot more areas than just pharmaceuticals.”
He adds that over time, as various programs are put into place, and as evidence of these programs affecting cost emerge, reform will naturally lead to different types of designs in benefits, formulary, or utilization management tools.
CMS Medicare Final Rule: Advancing Benefits, Competition, and Consumer Protection
May 7th 2024On this episode of Managed Care Cast, we're talking with Karen Iapoce, senior director of government products and programs at ZeOmega, about the recent CMS final rule on Medicare Part D and Medicare Advantage.
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Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
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AUA Session Highlights the General Urologist’s Role in Gender-Affirming Care
May 7th 2024During her session, Polina Reyblat, MD, Kaiser Permanente Los Angeles Medical Center, highlighted best practices urologists should incorporate to make transgender and gender-diverse patients comfortable during physical exams and avoid retraumatization.
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