Pharmacy Toolkit
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Featured Toolkits
ACA Risk Adjustment | Care Management | Customer Journey Mapping | MA Call Scripts | Medicare Advantage | Member Experience | Pharmacy | Reference-Based Pricing | SIU Org Charts | SDoH | Star Ratings | VBC and VBP
Audio: Pharmacy Roundtable: Organizational Structures, Roles and Staffing
Health Alliance Plan and other member plans share and collaborate about their pharmacy department organizational structures and discuss challenges with staffing and managing the department.
Presentation: Financial Transparency and Analytics for Managed Care Organizations
Truveris examines how best to create transparency throughout every stage of your PBM contract life-cycle, as well as align your internal management team to focus on a few key metrics and leverage industry trend analysis.
Presentation: Management of biosimilars across the enterprise
Presbyterian Health Plan shares an overview of the process utilized with key medical group stakeholders in Gastroenterology & Rheumatology to develop and implement practice guidelines and protocols for the use of biosimilars across the enterprise.
Presentation: Oncology utilization management
Scott & White Health Plan implemented a successful solution to address the challenge of cost management and benefits review for oncology services, presented at the Pharmacy Summit May 30, 2019.
Presentation: Opioid overuse strategies
Sentara & SelectHealth share overviews of the programs and strategies they have employed to address both acute and chronic opioid overuse, detoxification programs in addition to prescriber interventions. Presented at the pharmacy summit held in Dallas on May 29 and 30, 2019.
Presentation: Specialty Pharmacy Management Strategies & Innovations
The cost of specialty pharmacy is a rising concern for patients, providers, and payers. Cooperative Benefits Group reviews specialty trends in both cost and utilization as well as the drivers of specialty Rx growth and innovative approaches to reducing spend.
Prescription Drugs Trends Analysis: Medicare Part D and Medicare
The Menges Group provides a 5-slide analysis of volume and expenditure trends in the prescription drugs industry for Medicare Part D and Medicaid. Included also is data about Specialty prescriptions.
Specialty Pharmacy Industry Outlook: What's Next
A comprehensive overview of the Specialty pharmacy market including key trends, public policy, pricing and persceptives from Wall Street.
PBM Payer Mergers and Integrations
In this April, 2019 presentation, Cleveland Research provides an in-depth overview of PBM payer mergers and integrations.
Presentation: What Your PBM Doesn't Want You To Know - Delivering Savings and Better Care with Financial and Performance Transparency
Truveris pharmacy benefit experts Rahul Singal, MD and Ryan Hanes, MBA demonstrate how to create transparency throughout every stage of your PBM contract life-cycle, as well as align your internal management team to focus on a few key metrics and benchmarks.
Alternative Models for Pharmaceutical Rebates
The combination of rising drug costs at the health system level and increasing financial stress for individual patients has triggered intense national concern. One target has come under particular scrutiny: rebates. This white paper provides policy perspectives on alternative models for pharmaceutical rebates.
2018 Alliance Pharmacy Benefits Survey
Results of the 2018 survey of Alliance member pharmacy leaders covering pharmacy operations, vendors used, challenges, prioritiies, and topics desired for future Alliance programming.
Opiod Education Member Letter
SelectHealth shares a member communication summarizing Medicare changes to opioid prescriptions, effective January 1, 2019.
Member Education Letter for Opioid Prescription Changes
Scott and Whilte Health Plan shares a member letter summarizing the Medicare changes for opioid prescriptions, effective January 1, 2019.
Presentation: Changes coming that will impact pharmacy costs - MA Part D focus
Milliman expert Katie Holcomb discusses the types of changes that could be coming in the near future and what their potential impacts on pharmacy costs could be, with a particular focus on the Medicare Part D market. In recent years, pharmacy costs have received increasing attention, among insurers as well as legislators and the general public. CMS, MedPAC, HHS, and President Trump have all commented on potential ways to lower drug prices, reduce patient out-of-pocket costs, and improve care.