Reimbursement
CMS Proposed Outpatient Payment Rule Threatens Essential Funding, ASHP Argues
CMS has released one of its largest annual proposed payment rules, the Hospital Outpatient Prospective Payment ...
AUGUST 14, 2025
Will the IRA Harm the Financial Integrity of LTCs?
Changes to Medicare Part D reimbursement policies could lower operating margins for long-term care pharmacies.
AUGUST 12, 2025
Heads Up: 8 Payment Changes and Challenges in 2025!
We’ve entered a new year and a new era with major proposed changes to healthcare. How sturdy are your three ...
APRIL 10, 2025
NASP Urges Action on 'Abysmal' Medicare Reimbursement
Medicare Part D contract rates for specialty pharmacies for 2024 and again in 2025 are “abysmal,” Julie ...
OCTOBER 11, 2024
Finances May Hinge on Biosimilars, PAs
This month’s column primarily covers two major issues confronting pharmacy: prior authorization and the ...
AUGUST 11, 2024
PBM Cuts, DIR Fees And Audits Add Dour Note to the New Year
Pharmacy benefit managers have responded to the new CMS rule requiring them to account for all ...
FEBRUARY 12, 2024
PBMs Implement Sweeping Reimbursement Cuts and Ramp Up Audits
Pharmacy benefit managers have responded to a new CMS rule requiring them to account for all ...
DECEMBER 26, 2023
Payment for Key Community Oncology Services May Lag Inflation by 28% or More
An analysis of payment to physicians conducted for the Community Oncology Alliance by Avalere Health examining ...
NOVEMBER 13, 2023
More on Required Modifiers Under IRA of 2022
Payors, including Medicare, may want to capture particular types of data or use payment information for policy ...
AUGUST 7, 2023
What’s So Special About Pass-Through Drugs?
Whether you are a provider in an inpatient or outpatient setting, or a payor needing to track or project ...
OCTOBER 19, 2022
Navigating Legal Pitfalls in Payor– PBM Networks
The price of failing to accurately navigate specialty pharmacy networks can range from one-year bans to attracting ...
OCTOBER 7, 2022
Millions Recouped Via Flipped Infusion Claims
Pharmacists at UNC Medical Center, in Chapel Hill, N.C., are showing their worth when navigating the intricacies of ...
OCTOBER 6, 2022
