POCP Blog

Well-Intentioned CAQH Releases PA Operating Rules for Disappointing X12 278

By  Ken Kleinberg, Practice Lead, Innovative Technologies CAQH’s (Council for Affordable Quality Healthcare) recently released their new Phase V CORE Operating Rules for prior authorization (PA) that improve on specificity …

CARIN Alliance Workgroup to Help Advance Real-Time Pharmacy Benefit Check for Patients

By Pooja Babbrah, Practice Lead, PBM Services  The CARIN Alliance—a large, multi-stakeholder coalition–has formed a workgroup aimed at advancing the consumer-facing, real-time pharmacy benefit check (RTPBC). The goal is to …

Urgent Need for Real-Time Pharmacy Benefit Check Confirmed in Senate Committee Hearings

By Pooja Babbrah, PBM Services Practice Lead In mid-March, I was invited to testify in front of the U.S. Senate Special Committee on Aging at a hearing they held focused …

Health IT Will Help Achieve the Value in Value-Based Care in 2019

By Tony Schueth, CEO & Managing Partner How we pay for health care is undergoing a disruptive, fundamental shift. We rapidly are moving away from the traditional fee-for-service, pay-for-volume approach …

Efforts to Automate Specialty Pharmacy Will Accelerate in 2019

By Tony Schueth, CEO and Managing Partner Specialty medications are high-cost, complex drugs with special handling and delivery requirements. They are primarily used to treat rare or chronic conditions. Retail …

Electronic Prior Authorization On the Radar to Improve Medication Access

by Tony Schueth, CEO & Managing Partner A growing number of medications require prior authorization (PA) before they can be dispensed. This is a concern among providers, who are very …

Feds’ Year-End Guidance Will Affect Electronic Prescribing and EHRs

By Tony Schueth, CEO and Managing Partner The world of health IT was buzzing this week in the wake of a massive rule drop by the Office of the National …

Beyond the AI Hype: Practical Applications to Augment Medication Management Decisions (Part 2)

By Michael Solomon, Ph.D., MBA This is the second of a three-part series on AI applications to support prescription drug prescribing and therapy Amidst the uncertainty of healthcare policy and …

POCP Responds to Proposed Regulation Requiring Adoption of Real-Time Pharmacy Benefit Check by Medicare Part D

By Tony Schueth, CEO and Managing Partner Medicare Part D could adopt the Real-Time Pharmacy Benefit Check (RTPBC) beginning as early as January 1, 2020. That is what’s proposed in …

Opioid Law Creates Mandates for ePrescribing under Medicare Part D

By Tony Schueth, CEO and Managing Partner Changes are coming to electronic prescribing (ePrescribing) under Medicare Part D, as part of sweeping new legislation concerning the opioid epidemic that was …