Pharmacy Benefits

Does the number 835 mean anything to you? It should. You need to make sure there’s language in your audit rights with your PBM contract that allows access to the 835 file.

While 2020 was a year that most of us would like to forget, a lot of movement happened in the world of pharmacy and pharmacy benefits. We at Team Apex saw several themes in 2020 and summarize many of our …

The holidays came a little early for Arkansas pharmacists when the Supreme Court of the United States (SCOTUS) provided its 8-0 opinion on the Rutledge vs. PCMA case in the favor of the State of Arkansas. The recent decision was …

More and more self-funded employer group health plans are making some tough choices for 2021 and beyond with their plan benefits.

This is the next large step beyond the PillPack acquisition in 2018. Amazon says that Prime members can get discounts of up to 80 percent on generic drugs and 40 percent on brand-name medications when paying without insurance.

While this in theory sounds like a good idea – streamlining of data, integration of medical and pharmacy deductibles and out of pocket fees, etc. – it’s important to understand preferred relationships of any kind. Who benefits from this streamlining …

There’s a difference between receiving a certificate and receiving a certification. But what’s the difference? Why does it matter? A key difference between the two is experience. While a certificate is usually for newcomers and experienced professionals, certifications typically requires …

Many think that in the land of pharmacy benefits there are only three major players – CVS/Caremark/Aetna, Express Scripts/Cigna and OPTUMRx/United Healthcare. While it’s true, they do own a big share of the market. They control somewhere between 70-85 percent …

Many local businesses forced to shut down during the pandemic started in March have suffered financial loss, or even closed permanently.

A recent report by EvaluatePharma released a list of their top drugs by projected sales in 2026. There are three big observations from this data.

The way drugs are billed when they are dispensed by a doctor’s office or an infusion center is different than drugs purchased from a pharmacy–and a lot more expensive.

There’s a lot of talk about vertical consolidation of healthcare plans with PBMs. But have you considered what this means for the 10 largest ones?