As health care moves toward a value-based payment model, the pharmacy benefit is going in the opposite direction, one that places unit cost over clinical appropriateness. Have you ever used your drug ...

Covered drugs are arranged by cost in tiers or levels. Generics are in the lowest tiers and are generally the lowest cost. Coverage and drug lists vary from plan to plan. Plans can change covered ...

Millions rely on Medicare Part D, but many prescription drugs won't be covered in 2026. See which meds are excluded, why, and ...

CMS has launched the BALANCE Model, a five-year test to lower costs & expand Medicare access to GLP-1 weight-loss drugs while ...

Successful formulary system management can help ACOs achieve high quality, low cost objectives across the care continuum. This article targets healthcare leaders choosing to participate in the ...

Starting Jan. 1, 2025, millions of Americans who get their prescription drugs through Medicare could get a major financial break when a $2,000 out-of-pocket spending cap on medications goes into ...

A large academic medical center implemented a charitable care formulary with clinical pharmacist oversight, which resulted in more efficient usage of funds and fewer readmissions. Objectives: A large ...

Insurance companies don't cover some medications, which often leaves consumers responsible for the full costs. If your prescription is not covered, you can try generics, biosimilars, or other ...

Many patients, even those with insurance, have difficulty paying for their prescription medications. [1] What assistance is available? This seven-part strategy can help healthcare providers play a ...

Question: My part D plan doesn’t cover one of my medications. Can I just pay for it with cash? Answer: I often have individuals tell me this time of year that next year one of their medications are ...