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Medical billing, a payment process in the United States healthcare system, is the process of reviewing a patient's medical records and using information about their diagnoses and procedures to determine which services are billable and to whom they are billed. [1] This bill is called a claim. [2]
With such steep prices by 2012 specialty drugs represented 15-20% of prescription drug reimbursement claims. [60] Patient advocacy groups that lobby for payment for specialty drugs include the Alliance for Patient Access (AfPA), formed in 2006 and which according to a 2014 article in the Wall Street Journal "represents physicians and is largely ...
When filing an insurance claim, patients usually are charged an insurance copayment which is based on the public list price, and not the confidential net price. Around a quarter of the time, the cost of the insurance copayment on the list price is more than the entire price of the drug bought directly in cash.
Humana Inc. is an American for-profit health insurance company based in Louisville, Kentucky. In 2023, the company ranked 42 on the Fortune 500 list, [2] which made it the highest ranked (by revenues) company based in Kentucky. It is the fourth largest health insurance provider in the U.S. [3]
Express Scripts is known to reimburse pharmacies below cost for medications and push patients to only use their mail order service. They then will spread price the medication and charge the plan sponsor a much higher price for the medication than they will reimburse pharmacies for.
Users of Department of Defense's TRICARE Online can use the Blue Button to download their medications, allergies, and lab results as a PDF or text file. [23] Organizations like Medicare or Aetna offer health claims information as a downloadable text file. Using Blue Button, patients have an easy way to retrieve and keep track of their health.
The 340B Drug Pricing Program is a US federal government program created in 1992 that requires drug manufacturers to provide outpatient drugs to eligible health care organizations and covered entities at significantly reduced prices.
The following are settlements reached with US authorities against pharmaceutical companies to resolve allegations of "off-label" promotion of drugs. Under the Federal Food, Drug, and Cosmetic Act, it is illegal for pharmaceutical companies to promote their products for uses not approved by the Food and Drug Administration (FDA), and corporations that market drugs for off-label indications may ...
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