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Pharmaceutical reimbursement: an overview.

Philip E Johnson1

  • 1H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612-9497, USA. Johnson@moffitt.usf.edu

American Journal of Health-System Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists
|February 9, 2008
PubMed
Summary
This summary is machine-generated.

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Medicare pharmaceutical reimbursement rules impact healthcare finances. Pharmacists can improve revenue through better billing and collaboration, addressing drug handling costs and off-label use acceptance.

Area of Science:

  • Health Policy
  • Pharmacy Practice
  • Healthcare Finance

Background:

  • Medicare pharmaceutical reimbursement is complex.
  • Centers for Medicare and Medicaid Services (CMS) aims for budget neutrality.
  • Quality indicators and medical error penalties affect health systems.

Purpose of the Study:

  • To describe Medicare program authority, structure, and rules for pharmaceutical reimbursement.
  • To address billing issues, compendia expansion, and off-label drug uses.
  • To examine cost basis problems and participant collaboration needs.

Main Methods:

  • Analysis of Medicare program rules and regulations.
  • Review of current and proposed pharmaceutical reimbursement policies.
  • Examination of healthcare revenue stream dynamics.

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Main Results:

  • Pharmaceutical reimbursement rates have declined.
  • Financial penalties for not reporting quality indicators are implemented.
  • Proposed rules may expand accepted compendia and off-label drug uses.

Conclusions:

  • Understanding Medicare reimbursement complexities aids financial viability for institutions.
  • Pharmacists' efforts in billing can enhance revenue.
  • Collaboration is crucial for improving healthcare delivery and spending.