Report to the Congress: Issues in a Modernized Medicare Program |
From inside the book
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Page 4
... prior authorization and other techniques to manage drug utilization . Most plan members do not appeal denied formulary exceptions . Physicians frequently decide , when told of the prescribed drug's nonformulary status , that the ...
... prior authorization and other techniques to manage drug utilization . Most plan members do not appeal denied formulary exceptions . Physicians frequently decide , when told of the prescribed drug's nonformulary status , that the ...
Page 5
... prior authorization , and formulary exceptions processes in order to receive credit for their out - of - pocket spending toward the $ 3,600 catastrophic limit . Although the MMA explicitly lays out the structure of this standard Part D ...
... prior authorization , and formulary exceptions processes in order to receive credit for their out - of - pocket spending toward the $ 3,600 catastrophic limit . Although the MMA explicitly lays out the structure of this standard Part D ...
Page 7
... prior authorization request Percentage of appeals that are overturned Frequency of updates to clinical safety messaging software Percentage of drugs contraindicated for the elderly on prior authorization Number of adverse drug ...
... prior authorization request Percentage of appeals that are overturned Frequency of updates to clinical safety messaging software Percentage of drugs contraindicated for the elderly on prior authorization Number of adverse drug ...
Page 9
... prior authorization policies can influence members ' drug utilization . The MMA states that Part D plans are expected to use a variety of drug utilization management activities , some of which they currently employ with their commercial ...
... prior authorization policies can influence members ' drug utilization . The MMA states that Part D plans are expected to use a variety of drug utilization management activities , some of which they currently employ with their commercial ...
Page 10
... prior authorization for drugs that are on the formulary . The panelists considered other performance measures that could reflect access , but many again noted that the data might be ambiguous . For example , the ratio of formulary to ...
... prior authorization for drugs that are on the formulary . The panelists considered other performance measures that could reflect access , but many again noted that the data might be ambiguous . For example , the ratio of formulary to ...
Common terms and phrases
AAPCCs acquisition cost acute agency APCs average benchmarks case-mix changes clinical CMS's composite rate Congress cost-based cost-effectiveness analysis counties dialysis differences discharge discount drug benefit drug spending effectiveness eligible enrollees enrollment erythropoietin ESRD estimate evaluate FFS program formulary freestanding functional status Government Accountability Office handling costs health plans health service home health hospital-based improve incentives increase injectable inpatient Lewin Group measures Medicaid Medicare Advantage Medicare beneficiaries Medicare Payment Advisory Medicare Prescription Drug Medicare program Medicare's MedPAC analysis metropolitan statistical areas outcomes outpatient PPS payment areas payment policy payment rates payment system PBMs percent pharmacists pharmacy plan's post-acute premiums prescription drug prior authorization private plans radiopharmaceuticals receive recommendations regional PPOs rehabilitation Reischauer require researchers risk adjustment RUG-III rural hospitals RVUS Secretary SPAPs therapy update variation