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Four ways we're addressing pharmacy costs

Posted by AllWays Health Partners blog team on February 05, 2020

UPDATE: Federal law is beginning to move towards a solution to high prescription drug prices. The U.S. Supreme Court will soon take up a case on whether states can regulate certain aspects of prescription drug reimbursement, essentially taking on pharmacy benefit managers (PBMs) and protecting pharmacies from below-cost reimbursements. In addition, the “Lower Costs, More Cures Act” was introduced in December with the aim to lower out-of-pocket spending, protect access to new medicines, and strengthen transparency, accountability, and competition. This act has considerable bipartisan support, making it likely to pass.

Today's post is from our broker blog, AllWays Insider, which is exploring pharmacy cost trends in a series of posts.  

Because many of the dollar amounts reported on cost increases are so staggering, health plans and pharmacy benefit managers (PBMs) are working together to address increasing drug costs. Here are four measures aimed to control premium and out-of-pocket insurance costs and help manage prescription drug costs.

 

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Get to know Medical Director Dr. Lily Kam

Posted by Amanda Melgaco on November 14, 2019

The AllWays Health partners medical directors are practicing physicians who help us to ensure that members are getting safe, appropriate, cost-effective care. Among other duties, they write and review our medical policies and advise our clinical staff. 

We sat down with Dr. Lily Kam, one of our four medical directors, to learn more about her focus on community health throughout her journey from a medical student in Hawaii to a health plan medical director.

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9 things to check for coordination of benefits

Posted by Carolyn Zachariah on October 22, 2019

The patient is at your front desk, smiling wide. They declare that they have had a change in insurance, and now they have DOUBLE the coverage. TWO HEALTH PLANS! Their triumphant look likely means they don’t know how much extra work this could be for the practice.

Coordination of Benefits (COB) is the process we use to figure out the primary and secondary coverage when someone has more than one policy. The many rules can be a bit confusing, so here are 9 things your practice should know about COB.

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Is your number unlisted? Why unlisted CPT codes can cause trouble when filing claims.

Posted by Christine Murphy on August 22, 2019

Recently we published an article about the anatomy of a CPT code. In it, we explained how these digits keep everything clear and consistent for payers and providers. But what about unlisted codes? Some payers have stopped accepting them altogether. Here's why. 

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UPDATE: Universal provider directory tool

Posted by Steve Wong on August 13, 2019

HealthCare Administrative Solutions, Inc. (HCAS) is a non-profit organization founded by several Massachusetts health plans, including AllWays Health Partners. Our goal is to simplify certain administrative tasks, and our first major initiative is a universal provider directory tool. 

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Topics: Doing business with payers, News