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The $80+ Billion Price Tag of Healthcare Fraud

  • 2/25/2022
  • Specialty Pharmacy Continuum

Each year, healthcare fraud and abuse drains off tens of billions of dollars that might have gone to lower medical insurance premiums and expanded prevention and treatment services for patients. Although countering these schemes can be difficult, data mining and other interventions may help to defray at least some of the damage, experts noted during a recent webinar.

3 forecasts for the PBM industry in 2022

  • 1/27/2022
  • MedCity News

The current landscape heading into 2022 will keep pharmacy benefits under the microscope. Plan sponsors will evaluate their PBM’s pricing model to determine if their contract will deliver predictable costs, more opportunities for increased savings and improved care for their members.

Regain control of drug spend in 2022: 3 pharmacy benefits trends to watch

  • 12/29/2021
  • BenefitsPRO

In an environment where health care challenges continually evolve, new opportunities emerge for plan sponsors to strategically invest in their relationships with pharmacy benefit management (PBM) partners. Here are three pharmacy benefits trends that plan sponsors should consider when making their benefits decisions for 2022.

Health tech startups vie for a piece of drug supply chain

  • 10/13/2021
  • Politico

A TECH TWIST ON DRUG BENEFITS: Can a group of health tech startups disrupt the world of pharmacy benefit managers and seize part of a market forecast to be worth as much as $700 billion by the middle of the decade? Companies such as Capital Rx, WithMe Health and Navitus see an opening, and are using high tech dashboards and data mining in a bid to supplant industry giants...

Gaining the upper hand on pharmacy benefit fraud, waste and abuse

  • 9/20/2021
  • BenefitsPRO

How pharmacy benefit managers (PBMs) can help drive improved health care performance, financial results and member safety.

Kansas Investigates Obscure But Powerful Part Of The Drug Supply Chain: Pharmacy Middlemen

  • 8/13/2021
  • NPR in Kansas City

Some states have dumped their middlemen and switched to competitors among a much smaller but growing group of companies that bill themselves as a kind of countermovement to the biggest market players.

Specialty pharmacy operator Navitus acquires EpiphanyRx

  • 7/26/2021
  • Phoenix Business Journal

Madison, Wisconsin-based Navitus Health Solutions, which has a specialty pharmacy in Phoenix, has acquired EpiphanyRx, a pharmacy benefits management solution based in Brentwood, Tennessee.

Navitus Debuts Predictive Tool to Prevent Opioid Misuse

  • 7/22/2021
  • RADAR on Drug Benefits

Navitus Health Solutions has added a predictive analytics product to its Opioid Safety Solutions offering. The product, Predictive Analytics for the Misuse of Opioids (PAMO), generates member-specific risk scores to help prescribers identify who may be at risk of opioid misuse and recommend non-opioid treatment options.

PBMs and Drug Spending in 2020

  • 7/14/2021
  • Drug Channels

Adam Fein of the Drug Channels Institute shares his analysis of the 2020 commercial drug trend data for CVS Health, Express Scripts, Navitus and WellDyne.

Companies ditching massive drug-industry middlemen in favor of smaller competitors

  • 6/28/2021
  • Business Insider

Pharmacy benefit managers are facing a wave of fresh scrutiny from states over the secretive ways they turn profits. That's helping to fuel business at smaller firms and venture-backed startups that say they operate differently.

Madison-based Navitus, with Costco as part owner, expands its drug benefit business

  • 6/7/2021
  • Wisconsin State Journal

With nearly 1,000 employees and new partial ownership by Costco, Madison-based Navitus Health Solutions is growing in a pharmacy benefits industry dominated by a few companies whose opaque practices have led to transparency laws, including one adopted this year in Wisconsin.

Costco Brings Its Low-Price Magic to Employer-Paid Drug Plans

  • 4/22/2021
  • Bloomberg Businessweek

Pharmacy benefit managers typically make money by taking a cut of the drug price savings they negotiate for employers. Navitus says its fee-only model avoids financial conflicts.

Building relationships for better health: 3 patient interventions to improve adherence

  • 4/21/2021
  • Drug Store News

The financial and health implications of medication nonadherence are staggering — costing the U.S. healthcare system between $100 and $290 billion annually and taking the lives of 125,000 people each year. When patients fail to take their medications as directed, they are at risk of disrupted treatment, disease progression, increased hospitalizations and unnecessary medical costs.

4 FAQs (and answers) employers may have about COVID vaccinations

  • 4/6/2021
  • BenefitsPRO

Employers should be prepared to communicate their organization’s point of view on any vaccine requirements, says Brent Eberle.

How to achieve a drug formulary that reduces costs and maintains access to care

  • 3/22/2021
  • BenefitsPRO

Wasteful drugs could be driving up your pharmacy benefits spend–here’s how to evaluate, identify and establish a high-performance formulary.

The Journey to Improve Population Health

  • 3/15/2021
  • DiscoveRx Magazine

Through managed care pharmacy, [University of Wisconsin-Madison School of Pharmacy] alumna Eileen Murphy improves outcomes for Medicare patients.

Navitus: a 'Full Pass-Through' PBM Working to Improve Medication Adherence

  • 1/29/2021
  • Tuning in to the C-Suite: an MHE Podcast

MHE Associate Editor Briana Contreras and Senior Editor Peter Wehrwein speak with Julie Olson, senior director of Population Health and Product Development at Navitus, a full pass-through pharmacy benefits management (PBM) company.

Pharma benefits in 2021: 4 trends to watch

  • 12/24/2020
  • BenefitsPRO

While organizations will continue to invest in PBM partners to achieve cost savings, a few key areas will drive significant impact in 2021.

Top Drug Approvals and Product Launches of 2020

  • 12/10/2020
  • Drug Topics

A look back at the most impressive drug approvals and product launches of the year.

Opioid overdoses are spiking amid the pandemic - PBMs can help combat opioid abuse and misuse

  • 11/24/2020
  • MedCity News

Opioid overutilization is a public health crisis, and PBMs with programs aimed at curbing abuse and educating providers can have a positive and substantial impact on clients and their members.

In Land of Giants, Smaller PBMs Find a Niche

  • 10/15/2020
  • Managed Healthcare Executive

In the consolidated PBM industry, smaller companies say they can be nimble and not driven by rebates. But are they acquisition targets?

3 strategies to promote the value of medication adherence among plan members

  • 10/1/2020
  • BenefitsPRO

As the pandemic creates lasting effects on our economy and health care system, the major barriers to medication adherence have worsened.

A Look at the Year in Generics

  • 9/9/2020
  • Drug Topics

The generic pipeline continues to provide significant value to payers and patients as key products in top therapeutic classes lose patent protection.

Maintaining affordable access to prescriptions in a post-pandemic world

  • 5/29/2020
  • MedCity News

As the Covid-19 pandemic continues to evolve, pharmacy networks have largely delivered against the challenge to meet critical health care needs. Pharmacies across the country remain open to accommodate patients, and anticipated drug shortages and supply chain concerns from early in the pandemic have not come to fruition.

Navitus Achieves Double-Digit Savings for New Clients in 2019

  • 5/28/2020
  • RADAR on Drug Benefits

Navitus Health Solutions, a PBM that touts a 100% rebate pass-through model and a lowest-net-cost formulary, says it is seeing success in moderating total net cost per-member per-month (PMPM), particularly for new clients.

The company’s 2019 Drug Trend report, released in May, said Navitus achieved an “industry-leading” total net cost PMPM of $78.12 across its commercial business, 16% lower than the forecasted industry average of $93.11 PMPM.

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