Smarter Decisions, Superior Outcomes

Kathleen Sabo

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Managing Trends and Prescribing of Orphan Drugs

Posted by Kathleen Sabo on April 10, 2018 at 1:11 PM

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The development of orphan drugs, those used for the safe and effective treatment, diagnosis or prevention of genetic and rare diseases or disorders, is on the upswing.

In the past five years, 61 orphan drugs were approved. This is the largest for any five-year period since 1983, when Congress passed the Orphan Drug Act, a measure that gives financial incentives to encourage companies to develop drugs and biologics for rare diseases. The legislation includes tax credits to defray the costs of clinical trials and provides for fast-track FDA approval and market exclusivity. It's important because, before its passage, drug companies were weighing the financial viability of researching and developing these drugs. The Orphan Drug Act led to the development of hundreds of new drugs to treat a variety of conditions.

With orphan therapies on the rise, more people with rare diseases and genetic disorders have more treatment options designed to help them lead healthier, more productive lives.

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Topics: High Cost Medications, pharmacy spend, orphan drugs, health plan management, population health, patient outcomes,, drug costs,, rising drug costs,, specialty drug pipeline,

Managing Off-Label Prescribing in your Pharmacy Benefit

Posted by Kathleen Sabo on February 21, 2018 at 9:00 AM

Antidepressants for alcoholism, oral contraceptives for menstrual disorders, stimulants for weight loss; all of these are examples of off-label drug prescription use. It's a common practice, but is it safe or is it misuse or even abuse? The answer is, that depends.

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Topics: Coverage Determination Process, Prior Authorization, Prior Authorization Processing, opioids, health plan management, population health, patient outcomes,, FDA drug approvals

3 Common Myths about Prior Authorization Carve-Out

Posted by Kathleen Sabo on February 15, 2018 at 10:49 AM

There are three common myths circulating in the employer benefits marketplace regarding prior authorization (PA) services:

  1. All PA Programs are the same.
  2. My PBM won’t let me.
  3. It’s too confusing for members.

In this article, we’ll explore and dispel those myths and provide
a glance at the value of carving-out these programs from the pharma
cy benefit management contract. Successful PA programs, when managed effectively, are the gatekeeper to controlling soaring pharmacy expenditures while ensuring the right patient gets the right drug in the right dose at the right time.

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Topics: High Cost Medications, Controlling Pharmacy Expenditures, pharmacy spend, Coverage Determination Process, Prior Authorization, Specialty Drug Cost Control, Prior Authorization Processing, health plan management, population health, healthIT, data accessibility, patient outcomes,, drug costs,, rising drug costs,

3 Types of Data to Help Make Provider Decisions Smarter

Posted by Kathleen Sabo on August 15, 2016 at 11:00 AM
 
With a wide range of patient information collected throughout hospitals, physician’s offices, and medical and pharmacy claims, we have seen an unprecedented amount of information waiting to be used by physicians and providers alike. Healthcare providers need accessible data to make the best clinical decisions at the point of care. But quality healthcare depends on the quality data.
 
Quality data allows for more accurate diagnoses, more effective treatment strategies, and provide higher quality service overall. In this article, we examine three valuable sources of data that every provider should leverage in order to make smarter decisions.
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Topics: Meaningful Use, data sharing, EHR, provider workflow,, data quality

How Will the New 'Orphan Drugs' Affect Pharmacy Expenditures?

Posted by Kathleen Sabo on February 19, 2016 at 12:08 PM

In recent years, the pharmaceutical industry has experienced slowing growth on a global scale, due in part to patent expirations, increasingly tough regulations and fierce competition from generics. One sector, however, has not suffered the same fate—specialty pharmacy.

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Topics: High Cost Medications, Controlling Pharmacy Expenditures, pharmacy spend, orphan drugs, Meaningful Use, Coverage Determination Process, Prior Authorization, Specialty Drug Cost Control, Specialty Drug

4 Essential Keys to a Solid ePA Knowledge-base

Posted by Kathleen Sabo on February 2, 2016 at 8:30 AM

ePA will continue to gain momentum.

Electronic Prior Authorization (ePA) is not going anywhere—and, we're not talking about the folks who test drinking water and lobby for reduction of air pollutants. There has been a lot of talk about ePA over the past year. In fact, Google records nearly 3.9 million results for the term and nearly every week there is a legislative update, industry news story, or forum on the topic. Don't expect that to change this year.

With benefit managers struggling under the weight of requirements from Federal rules like HIPAA, HITECH, and Meaningful Use, as well as State regulations, ePA has become an essential strategy for the evolution of pharmacy benefit programming and maintaining regulatory standards. However, the value of ePA reaches much further than compliance. ePA substantially increases efficiency in the continuum of care for everyone, including providers, dispensers, patients, health plans, and payors. Faxing forms is cumbersome and depends on old, outdated technology. With ePA, a determination can be received in just minutes, often times when the patient is still in the doctor's office. And, this value is what providers have been waiting for.

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Topics: Interoperability, NCPDP Standards, ePA, Meaningful Use, Coverage Determination Process, Prior Authorization, Interoperability Roadmap

Controlling Specialty Drug Spend through the Coverage Determination Process

Posted by Kathleen Sabo on January 26, 2016 at 8:00 AM

iStock_000016535503Large-1.jpgAccording to United Health Center for Health Reform and Modernization the United States spent $87 billion on specialty drugs in 2012, and that number is estimated to reach $400 billion by 2020. In 2014 alone the cost of specialty products alone has risen 13.1%. Specialty drugs now cost more than the median household income.

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Topics: High Cost Medications, Controlling Pharmacy Expenditures, Coverage Determination Process, Specialty Drug Cost Control, Prior Authorization Processing

Independent & Objective

Clinical expertise without the noise

Getting the facts matters. Following our corporate mission, we're committed to using this blog to enhance your knowledge of evolutionary events and discussions in the pharmacy services and technology arena. 

Here's what we're focused on right now:

  • Lowering ingredient cost
  • Enhancing the coverage determination process
  • Creating robust prior authorization criteria
  • Producing actionable drug trend analyses
  • Enhancing prescription drug monitoring 
  • Implementing interoperability efforts

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