How Prescription Drug Coverage Works: Formulary Tiers, PBM, Rebates, Spread-Pricing Explained скачать в хорошем качестве

How Prescription Drug Coverage Works: Formulary Tiers, PBM, Rebates, Spread-Pricing Explained

Learn How Prescription Drug Coverage Works with Health Insurance: 1) Formulary: There are Formulary and Non-Formulary Medications. Formulary Medications are Covered by Insurance. Non-Formulary Medications are Not. 2) Formulary Tiers: Typically Formularies Have Tiers 1-4 for Generics, Preferred Brand, Non-Preferred Brand and Specialty Medications. 3) Pharmacy Benefit Managers (PBMs): Negotiate the Formulary Tiers for Health Insurance Coverage in Exchange for 'Discounts' from Pharmaceutical Manufacturers. Also, PBMs Process the Pharmacy Claims for a Health Insurance Plan. 4) How PBMs Make Money: A) Rebates - Commissions Paid by Pharmaceutical Manufacturers to PBMs, Which the PBMs in Turn Pay Out--in part--to Their Employer Customers. B) Spread Pricing - The Markup PBMs Place on Generic Medications, Which is Then Paid by Their Employer Client. AHealthcareZ is 200+ Healthcare Finance Educational Videos. 💥 BOOK: Check out Dr. Bricker’s Book 16 Lessons in the Business of Healing here: https://www.ahealthcarez.com/healthca... AHealthcareZ Viewers Include: Employee Benefits Professionals, HR, CFOs, Insurance Brokers, Benefits Consultants, Doctors and Nurses in Leadership Roles, Hospital and Health System Administrators, Health Insurance Carrier and PBM Professionals, Pharma and Med Device Professionals, Academic Professors and Students in Healthcare Administration and Public Health. 90,000+ Views Per Month Across All Platforms. Visit AHealthcareZ.com to Subscribe to the Healthcare Finance Video Newsletter.