Providers Must Know Payer Contracts; PBMs Control 80% of Market; Orlando Health Reduces Wait Times
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- Matt Mulherin, chief growth officer for AC3 Health, emphasized that providers must know every detail of payer contracts and come to contract talks armed with data to back up arguments.1
- Sucharu 'Chris' Prakash, MD, highlighted that the Big 3 pharmacy benefit managers (PBMs) control 80% of the market and dictate who gets to fill prescriptions, impacting patient access to medications.1
- Prakash proposed several reforms for PBMs, including increasing transparency and limiting out-of-pocket costs for patients, which would help address the challenges faced by patients in accessing medications.1
- The Orlando Health Care Institute's centralized prior authorization team reduced patient wait times for medications to less than 48 hours by utilizing AI tools and pharmacist involvement.1
- Matt Mulherin, chief growth officer for AC3 Health, emphasized that providers must know every detail of payer contracts and come to contract talks armed with data.
- Sucharu 'Chris' Prakash, MD, noted that the Big 3 pharmacy benefit managers (PBMs) control 80% of the market, impacting patient access to medications.
- Prakash proposed reforms for PBMs, including increasing transparency and limiting out-of-pocket costs for patients.
- The Orlando Health Care Institute reduced patient wait times for medications to less than 48 hours by utilizing AI tools.