by Karen Apwah | Sep 11, 2024 | Opioid Overutilization, Part D Star Ratings
The Centers for Medicare & Medicaid Services (CMS) recently finalized changes to the Medicare Part D Star Ratings for 2024, introducing several new initiatives aimed at improving the quality of care and enhancing patient outcomes. These changes not only affect how...
by Karen Apwah | Jul 17, 2024 | CMS, Electronic Prior Authorization, Healthcare Technology, Prior Authorization
Are you prepared for potential upcoming AI Guidelines in Prior Authorization? As AI continues to revolutionize various aspects of healthcare, including prior authorization (PA) management, it’s crucial for Health Plans and Pharmacy Benefit Managers (PBMs) to stay...
by Karen Apwah | Jun 6, 2024 | Grievance Management, Healthcare Technology
With ongoing challenges such as the COVID-19 pandemic, rising healthcare costs, and changing regulatory requirements, healthcare organizations face increasing pressure to ensure efficient resolution of member grievances while maintaining compliance with industry...
by Karen Apwah | May 6, 2024 | Formulary Benefit Design
For Health Plans, PBMs, and TPAs, formulary management stands as a critical pillar in ensuring optimal patient care while managing costs effectively. As complexities surrounding formularies continue to mount, traditional approaches lack efficiency and are proving...
by Karen Apwah | Apr 15, 2024 | Adherence, CMS, Medication Therapy Management
The recent final rule for the 2025 contract year issued by the Centers for Medicare & Medicaid Services (CMS) carries significant implications for Health Plans and Pharmacy Benefit Managers (PBMs) managing Medication Therapy Management (MTM) programs. This change...
