“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.
As 2025 comes to a close, many organizations are planning celebrations to recognize the milestones they have reached this year. When organizations host end of year celebrations, they are providing an...
As a mid-size or growing employer, you may be challenged to balance competitive benefits offerings at a reasonable cost in a compliant manner. The IRS regulations around Affordable Care Act (ACA) ...
On October 11, 2025, Governor Gavin Newsom signed into law SB 41, enacting a broad set of changes to the ways in which pharmacy benefit managers (PBMs) can do business in the State of California....