A score was developed to measure patient risk from payer utilization management policies and its relationship to real-world US commercial payer utilization management policies.
Payers should consider providing higher reimbursement rates and/or preferred pharmacy networking status for pharmacies that provide chronic medications in blister packs for patients.
Veterans primarily receiving care through the Department of Veterans Affairs (VA) similarly used dental and vision services under Medicare Advantage (MA) and traditional Medicare, challenging the justification for full MA capitated payments based on supplemental benefits.