scholarly journals Variation in health plan specialty drug coverage: an empirical analysis

2019 ◽  
Vol 8 (sup1) ◽  
pp. 13-13
Author(s):  
Nikoletta M. Margaretos ◽  
Rachel C. Lai ◽  
Ari D. Panzer ◽  
James D. Chambers
Keyword(s):  
Empirical Analysis ◽  
Health Plan ◽  
Drug Coverage

scholarly journals RE1 DO HEALTH PLANS CITE REAL-WORLD EVIDENCE IN THEIR SPECIALTY DRUG COVERAGE POLICIES? AN EMPIRICAL ANALYSIS

2020 ◽  
Vol 23 ◽  
pp. S383
Author(s):  
A. Panzer ◽  
N. Margaretos ◽  
R. Lai ◽  
D.E. Enright ◽  
J. Chambers
Keyword(s):  
Empirical Analysis ◽  
Real World ◽  
Drug Coverage ◽  
Health Plans ◽  
Real World Evidence

scholarly journals A Prescription for Drug Formulary Evaluation: An Application of Price Indexes

2012 ◽  
Vol 15 (2) ◽  
Author(s):  
Jacob Glazer ◽  
Haiden A. Huskamp ◽  
Thomas G. McGuire
Keyword(s):  
Economic Theory ◽  
Health Insurance ◽  
Health Plan ◽  
Private Health Insurance ◽  
Drug Acquisition ◽  
Drug Coverage ◽  
Demand Side ◽  
Drug Formulary ◽  
Price Indexes ◽  
Acquisition Costs

Existing economic approaches to the design and evaluation of health insurance do not readily apply to coverage decisions in the multi-tiered drug formularies characterizing drug coverage in private health insurance and Medicare. This paper proposes a method for evaluating a change in the value of a formulary to covered members based on the economic theory of price indexes. A formulary is cast as a set of demand-side prices, and our measure approximates the compensation (positive or negative) that would need to be paid to consumers to accept the new set of prices. The measure also incorporates any effect of the formulary change on plan drug acquisition costs and “offset effects” on non-drug services covered by the plan. Data needed to calculate formulary value are known or can be forecast by a health plan. We illustrate the method with data from a move from a two- to a three-tier formulary.

Health Plan Denials and Appeals

2008 ◽  
Vol 18 (1) ◽  
pp. 27-32
Author(s):  
Sandra Schwartz ◽  
Janet McCarty
Keyword(s):  
Health Plan ◽  
Voice Therapy ◽  
Voice Treatment ◽  
Independent Review

Abstract Challenging health plan denials for voice treatment through appeals or advocacy efforts can pay off. This article describes the process of obtaining authorization for voice therapy, filing claims, establishing goals, preparing needed documentation, appealing claims through various levels including independent review, and developing an advocacy campaign if coverage is not offered or is very limited.

Obama Health Plan Adds to Employer System

Ob Gyn News ◽  
2008 ◽  
Vol 43 (15) ◽  
pp. 38
Author(s):  
MARY ELLEN SCHNEIDER
Keyword(s):  
Health Plan

Health Plan Feedback to Physicians Improves Asthma Care

2006 ◽  
Vol 40 (9) ◽  
pp. 58
Author(s):  
JANE SALODOF MACNEIL
Keyword(s):  
Health Plan ◽  
Asthma Care

Future Uncertain as Health Plan Settlements Expire

2008 ◽  
Vol 39 (4) ◽  
pp. 54
Author(s):  
ALICIA AULT
Keyword(s):  
Health Plan

CMS Seeks to End Health Plan Marketing Abuse

2008 ◽  
Vol 39 (7) ◽  
pp. 60
Author(s):  
JANE ANDERSON
Keyword(s):  
Health Plan
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