Utilization Management
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340B, Affordable Care Act, Caught my eye, CMMI, Drug Prices, DTC, Employers, Medicare Advantage, Medicare Part D, Reference Pricing, Supply Chain, Utilization ManagementAMP is WAC — 9/12/25
Read more: AMP is WAC — 9/12/25On one hand, a busy week in the world of health policy. The quicksand of news in 2025 is real so I do my best to sidestep some news (MAHA report) to dive into the things that I think are important for my clients – including expected premium spikes, 340B rebate backlash and Medicare changes.…
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340B, Caught my eye, Drug shortages, Pharmacy Benefit Managers, Supply Chain, Utilization ManagementAMP is WAC — 7/25/25
Read more: AMP is WAC — 7/25/25Next week we’ll have our first glimpse of the Medicare Part D premiums for 2026; I expect them to be pretty awful. The Part D redesign shifted additional liability onto plans without changing enough of the premium calculation. Some articles next week will say it is unintended consequence; I think it is an intended one…
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Affordable Care Act, Biosimilars, Caught my eye, Employers, Healthcare Costs, Inflation Reduction Act, Medicare Advantage, Medicare Part D, Pharmacy Benefit Managers, Utilization ManagementAMP is WAC — 6/27/25
Read more: AMP is WAC — 6/27/25In case you think I’m opinionated, just know that it could be so.much.worse. I often write something and then hit backspace, backspace, backspace. You’re welcome? Off next week for the 4th of July. Caught my Eye Tradeoffs. Last week USC put out a paper that reviewed how many Medicare Part D beneficiaries will likely pay…
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Getting nowhere fast
Read more: Getting nowhere fastMy mom said to never use the word hate but, honestly, I hate step therapy. I dislike prior authorization but step therapy, well I hate it. Both fall under the concept of utilization management which are barriers to access put up by payers (really pharmacy benefit managers (PBMs)) for cost or safety concerns. The idea…
Latest news
- AMP is WAC — 04/24/26
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