POCP Blog

Digital Therapeutics: Transforming Care through Technology

Part 1. What Are Digital Therapeutics? By Tricia Lee (Wilkins) Rolle, PharmD, MS, PhD Government Affairs and Health IT Strategist The patient swallows a pill with an embedded sensor. Within …

10 Things Payers Need to Know About Electronic Prior Authorization

By Jocelyn Keegan, Payer Practice Lead Payer interest is growing in electronic prior authorization (ePA). Initially, in many organizations, automation largely replicated the paper process requiring duplicate entry of information. …

CDS Hooks Are Win-Win-Win for Providers, Patients and Health IT Vendors

By Michael Burger, EDI Practice Lead CDS Hooks are a new SMART on FHIR technology that will enable providers to receive timely information about individual patients, their condition and potential …

Diving Deeper into CMS’ Proposed Rule on Electronic Prior Authorization for Medicare Part D Drugs

By Jocelyn Keegan, Payer Practice Lead, and Ken Kleinberg, Innovative Technologies Practice Lead The Center for Medicare and Medicaid Services (CMS) recently announced a proposed rule that would require use …

Emerging NCPDP Standard Enhancements to Improve Speed to Therapy for Specialty Medications

By Pooja Babbrah, Practice Lead, PBM Services Specialty medications are changing health care, providing life-saving treatment options for patients with rare and chronic conditions.  Patients, however, often face big hurdles …

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 …