Health systems and health insurance plans spend enormous sums of money battling over how to be paid fairly — and these battles have only intensified with the growth of Medicare Advantage plans, which ...

The administrative burden of utilization review processes like prior authorizations and concurrent review has long been a thorn in the side of healthcare providers. While prior authorizations have ...

I need to do a drug utilization evaluation (DUE) for a new product to be added to our formulary. What resources are available to develop a DUE? The formulary system encompasses facets of medication ...

Whether pharmacies have a due process interest in determining whether an injured worker's care is necessary under the Workers' Compensation Act was one of the key arguments in the first session led by ...

(Philadelphia, PA) – After examining data from six state Medicaid programs, researchers from the University of Pennsylvania School of Medicine have concluded that drug utilization review programs do ...

The powerful hospital lobby has been pushing a bill, A.3789 (Weprin)/S.7297 (Hoylman-Sigal), that would mandate arbitrary and impractical timelines on utilization review decisions – the process that ...