“J-Codes” and “medical specialty pharmacy” claims are going to be one of the top two procedure categories in terms of cost within your health plan. Knowing the amount of waste and abuse can give you insight into how you can develop strategies to drive more cost-effective utilization of the plan, and even enhance the benefits to the plan members for that efficient behavior. By identifying these specific issues within your plan and implementing targeted, value-based strategies to address them, you could eliminate tremendous costs without any adverse effects to your population.
Join our Director of Data Analytics, Scott Mayer, talks about the financial perils and pitfalls of "J-Codes" within an employer-sponsored health plan, and how the power of data can unlock the secrets to managing its spend.
We’ve all heard the phrase “doctor’s orders,” from a family member or friend reminding us to eat healthy or take our medicine. But it’s not a catchphrase. The advice a doctor provides is a real plan...
As healthcare systems grow more complex, as does the complexity for consumers trying to manage and understand their benefits. Yet many of the systems designed to support them often lack clarity and...
On June 30, 2025, the U.S. Supreme Court announced its decline to review decision in Pharmaceutical Care Management Association (PCMA) v. Mulready, a ruling by the U.S. Court of Appeals for the 10th...