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Are You Ready to Comply with 455? How the CMS Regulation Affects You.

A 2015 report estimates that approximately $60 billion of American tax money, or more than 10% of Medicare’s total budget, was lost to fraud, waste, abuse and improper payments in 2014.

Centers for Medicare and Medicaid Services’ (CMS) strategy for ridding the system of fraud has been to move away from a pay-and-chase system to a preventive model. Identifying high-risk providers on the front end is easier than tracking and unraveling complicated transactions on the back end.

To help reduce the risk of fraud, waste and abuse, CMS has established requirements for Medicaid programs to validate their networks. All Medicaid PBMs, especially Managed Medicaid PBMs, may bear the brunt of this risk assessment.

This webinar explores the new CMS regulation, the impact on PBMs, and how PBMs can use data, analytics and advanced technology to be in compliance.

Learning objectives:
  • Understand the scope of the 455 regulations as it relates to PBMs
  • Explore the kinds of data available to screen and validate providers
  • Evaluate data solutions to comply with 455 requirements and network validation
Bobbie Riley, RPh, Director, Pharmacy, LexisNexis Risk Solutions
Brian Eidex, Director, Pharmacy, LexisNexis Risk Solutions

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Findings from PBMI's 2018 Trends in Specialty Drug Benefits Report

Did you know that 58% of plan sponsors use coinsurance for member cost sharing over copayments?  Employers continue to look for creative ways to battle the growing cost of specialty drug trend while continuing to offer quality benefits for their employees.

Listen to this webcast to learn more about this strategy and many others employers are using to manage their specialty drug benefits.

Report and webinar sponsored by Walgreens and AllianceRx Walgreens Prime.

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Impacting Drug Trend: Spend Less, Get More

Analytics and patient engagement strategies are the foundation to understanding, building, and executing strategies to decrease drug spend and improve quality.

During this webinar, Michael T. Einodshofer, Chief Innovation Officer, Maxor Plus, examines these strategies and how they can be used to deliver a drug trend guarantee for clients.

Learning objectives:
  • Learn about innovative clinical strategies and formulary/benefit designs that decrease drug trend
  • Understand how clinical strategies and PBM savings can be bundled together into a “guarantee”
  • Apply examples to a case study that illustrates a drug trend guarantee
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