Change is Coming in Prior Authorization & Price Cost Transparency: Regulations, Standards & Adoption

Pricing: Free for Members and $30 for Non-Members

Course Description

Health care is experiencing a resurgence in industry drive and will to automate prior authorization (PA) and improve cost transparency for patients and providers. Standards, whether NCPDP SCRIPT, X12N, or HL7 FHIR, are just a part of the potential tools being used to meet these established and expected requirements. The industry has the opportunity to solve real challenges above and beyond automating existing blockers.

This session will provide an overview of CMS’ goals and vision, showcase real-world examples of what stakeholders across the continuum are doing to transform PA, and elaborate on the transparency of cost and affordability. Most importantly, this session will highlight how pharmacists can join the discussion to lend their voice and define their role in this business transformation to ensure they solve the challenges, reduce patient time to therapy, improve medication adherence, and automate PA, adding clarity to coverage, cost, and services available to help patients be adherent.

Target Audience

Pharmacists who practice in managed care settings.

Learning Objectives

At the completion of this activity, participants should be able to:

  1. Summarize the relationship between NCPDP and emerging HL7 FHIR standards.
  2. Identify key drivers for innovation in prior authorization and price transparency towards automation.
  3. Describe ways that automation and standards can streamline existing specialty prescribing steps.
  4. Describe how pharmacists can help progress prior authorization and price transparency.
Course summary
Available credit: 
  • 1.25 ACPE
    ACPE The Academy of Managed Care Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
  • 1.25 Certificate of Completion
Course opens: 
02/15/2023
Course expires: 
12/31/2023
Cost:
$30.00

Faculty

Kim Boyd
Sr Consultant, Regulatory Resource Center Lead
Point-of-Care Partners
Murfreesboro, TN

Alexandra Mugge, MPH
Director, and Deputy Chief Health Informatics Officer
Centers for Medicare & Medicaid Services
Baltimore, MD

Moderator

Tzuyin Kuo, PharmD
PharmD Fellow
University at Buffalo-NYS Department of Health
Buffalo, New York

 

Financial Relationship Disclosures

Faculty/Reviewer/PlannerReported Relevant Financial Relationships
Kim Boyd
Faculty		Employee(past): McKesson
Alexandra Mugge
Faculty		Disclosed no relevant financial relationships.

Michelle Aslami
Reviewer

Employee: Magellan Rx Management

Brittany V. Henry
Planner		Disclosed no relevant financial relationships.
  • AMCP Staff have disclosed no relevant financial relationships.
  • If applicable, relevant financial relationships have been mitigated and documented.
  • Content has undergone a peer review to ensure content validity.

Accreditation:

The Academy of Managed Care Pharmacy (AMCP) is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

ACPE UAN:0233-0000-22-052-H04-P  • Activity Type: Knowledge-Based
Contact Hours: 1.25
Release Date: October 12, 2022 •  Expiration Date: December 31, 2023
Activity Fee: Free for Members and $30 for Non-Members

Participants should claim continuing pharmacy education (CPE) credit for this home study activity only if they have not claimed credit for the live activity presented at Nexus 2022. CPE credit will be processed through the AMCP Learn portal and reported directly to CPE Monitor. Please allow 72 hours for processing and posting in your NABP account.

To receive credit for an online activity you must:

  • Review the full content of the activity.
  • Successfully complete the post-test (required to pass with a score of 70% or higher, it may be taken a maximum of three times).
  • Complete a specific activity evaluation.

Available Credit

  • 1.25 ACPE
    ACPE The Academy of Managed Care Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
  • 1.25 Certificate of Completion

Price

Cost:
$30.00
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Required Hardware/software

System Requirements Courses and learning activities are delivered via your Web browser and Acrobat PDF. For all activities, you should have a basic comfort level using a computer and navigating websites. View the minimum technical and system requirements for continuing education online learning activities