Genabio Diagnostics’ Post

At the Pharmacy Benefit Management Institute’s Annual National Conference in Orlando, panelists discussed new Centers for Medicare & Medicaid Services standards and technological advancements aimed at streamlining prior authorization for prescription drugs. The goal is to reduce administrative burdens and improve efficiency through seamless electronic prior auth processes integrated with health plan information and medical records. This shift represents a significant opportunity for prior auth automation companies to drive cost savings and enhance provider-patient experiences by leveraging new standards and building integrated solutions. Embracing these advancements can help bring the future of automated, efficient prior authorization processes closer to reality. For more about the recent panel, follow this link: https://hubs.la/Q02P0KCC0

Enable Continuous Improvement in Healthcare with the agile BPAMedical365®, https://lnkd.in/e7yDVY7R ☯ A brief guide on how to measure quality improvement in healthcare, https://lnkd.in/dBhnnCfu #healthcare #medtech #pharma #patientsafety #iso13485 #eQMS #qualitymanagement

The LNK team has been busy improving and expanding our services. We figured it was time to give an update on what we have accomplished and what we are working towards into the future. Since starting operations in June of 2023, we have made significant strides in improving medication access via prior authorization streamlining, financial assistance consulting, drug information consulting and patient education. Please see figure below for a snapshot of our recent achievements and what we’re looking forward to in the future. 🔍 Understanding the Data: Standard Approval: This represents the approvals received through the regular prior authorization (PA) process without any need for further appeals or interventions. Appeal Approval: These are the requests initially denied but later approved upon peer-to-peer or an appeal, demonstrating our commitment to ensuring patients receive medically necessary medications. Denials: The majority of these denials were due to contract exclusions of medications based on patients' prescriptions. We resolved these either by patients electing to pay cash or understanding they didn’t qualify for the medication but wanted to try. No PA Needed: These include all requests triaged either before submission of a PA or during the PA process. This involves alternative medication changes based on formulary coverage and individualized solutions provided outside of the PA process. Future Outlook: As we continue to grow and improve our processes, we are excited to expand into phase 2 of our business plan timeline. Our goal is to become the go-to resource for all pharmacy-related issues for both patients and providers, ensuring seamless and efficient medication management, and continuity of care. At LNK Pharmacy Solutions, we prioritize working towards pioneering a business model that empowers clinical pharmacists. Our platform is designed to transcend geographic barriers and bypass the constraints of traditional healthcare processes, enabling highly trained pharmacists to deliver exceptional care directly to patients and providers. By doing what they do best, our pharmacists help patients gain control over their healthcare by understanding their disease states, manage their medications effectively, navigate financial constraints when they arise, and ultimately improve their quality of life. Thank you to our dedicated partners, mentors, and patients for your continuous support. Together, we are making a significant impact on patient care and healthcare efficiency. Follow along as we revolutionize healthcare together! If you have worked with us before or have any questions, please comment below or reach out! We love to hear from our growing community! #PharmacySolutions #HealthcareInnovation #PatientCare #PharmacyServices #Telehealth

Check this out! 🚀 Our electronic prescribing solution simplifies workflows for all practitioners! Say goodbye to red tape and hello to streamlined processes! Here's what we offer: *Simplified Prior Authorizations *Clinical Support *Decision Support *Controlled Substances Management *Up-to-Date Formulary Data *Compliance Made Easy *Direct Pharmacy Connection *Patient Education Discover how NewCrop can enhance your practice by clicking on the link https://lnkd.in/eJjHNJYK.   Want to learn more? Message me direct 😊 #TherapyBrands #ElectronicPrescribing

Recently, the FDA launched Device Trial Participation Snapshots, which provide key insights into the clinical trials that support the approval of new medical devices. This initiative aims to enhance transparency and highlight the diversity of participants in these trials. By making demographic data more accessible, the FDA is promoting health equity and informed decision-making for both healthcare providers and patients. For the life sciences insurance industry, this move underscores the importance of comprehensive risk assessment and the need to consider diverse patient populations in underwriting processes. As we continue to support innovation in medical technology, understanding the varied impacts on different demographic groups will be crucial in developing robust insurance solutions. #SompoLifeSciences

CMS Releases CY 2025 Physician Fee Schedule Proposed Rule On July 10, 2024, CMS released its Medicare Physician Fee Schedule (PFS) Proposed Rule (CMS-1807-P). The rule proposes a 2.93 percent reduction in average payment rates under the PFS, driven by adjustments to the conversion factor and updates to relative value units (RVUs). The rule proposes to continue reimbursement for telehealth services, via audio-only communication, for any telehealth service furnished to a beneficiary in their home if the distant site physician or practitioner is technically capable of using an interactive telecommunications system but the patient is not capable of, or does not consent to, the use of video technology. Additionally, the agency proposes a shift in payment policy for care coordination services in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), moving from a single Healthcare Common Procedure Coding System (HCPCS) code to reporting individual Current Procedural Terminology (CPT) and HCPCS codes starting in 2025. The rule also introduces changes in drug payment policies, notably under the Medicare Prescription Drug Inflation Rebate Program, affecting both Part B and Part D drugs. This includes clarifications on rebate calculations and exclusion criteria for certain drugs, potentially impacting how these medications are priced and reimbursed. In the rule, CMS also introduced initiatives to enhance ambulatory specialty care through potential new models leveraging Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs). This approach seeks to foster value-based care coordination between primary and specialty care, potentially affecting how primary care providers (PCPs) collaborate with specialists under revised incentive structures. Comments to the rule are due by 5:00 p.m. on September 9, 2024. View the rule here: https://lnkd.in/g3An5iXH Read more: https://lnkd.in/e-ddUuRX

Continued increases in utilization of glucagon-like peptide-1 agonists (GLP-1s) are exerting pressure on healthcare cost trends and budgets, prompting a critical need for data-driven strategies to manage this growing financial strain. This white paper presents a quantitative analysis of GLP-1 utilization and cost, with a particular emphasis on anti-diabetic indicated GLP-1s in a sample of Medicaid managed care programs. Amine Elmeghni and Jim Davidson answer the following questions: 💡How does Medicaid preferred drug strategy impact GLP-1 utilization and spending on a gross and net cost basis? 💡What does emerging experience tell us about future utilization? 💡Does emerging experience show medical or pharmacy cost offsets for GLP-1 users? #Milliman #healthinsurance #medicaid

💊 The latest HIT Perspectives newsletter is out! This issue explores the impact of pharmacy interoperability on payers and provides valuable insights into the Pre-approval Information Exchange (PIE) process. It just so happens this is exactly what I'm writing about this week. Don't miss out on these game-changing industry trends! https://buff.ly/4erAoGj #pharmacy #healthcare #interoperability #HIT #PIE #payers #EHR

CMS Tackles Generic Drug Costs. The Centers for Medicare & Medicaid Services (CMS) has introduced a proposed list of generic drugs aimed at reducing cost-sharing burdens for patients. This initiative could significantly lower the out-of-pocket costs for essential medications. Key takeaways:  💠Reduced costs for essential generics  💠Potential positive impact on patient care    💠More equitable access to critical medications Want to know more about how this proposal could change healthcare? Check out the full article: https://lnkd.in/eEu8qwHJ #generics #Healthcare  #medicare #medicine #pharma

What if there were no barriers across the therapy access and reimbursement process? In his latest Drug Channels article, @Kevin Kettler explores how CoverMyMeds brings stakeholders together to break down barriers that stand between patients and the medicine they need. From mitigating financial constraints to navigating complex prescribing journeys and insurance requirements, we help pharma companies benefit from the reach of our network. https://lnkd.in/eiut2dYN