Category Archives: Industry Insights

Intro: There are several publications on the Food and Drug Administration’s (FDA) activities over time, but specific information on specialty drug approvals and trends since 1990 are difficult to find. Our overall purpose for this blog is to review the history of approvals and trends since 1990 for specialty medically covered drug.  Initially, we will […]

Myasthenia Gravis is a neuromuscular disorder that impacts over 50 thousand patients in the United States (U.S.). Of those patients that are diagnosed, approximately 95 percent are treated with immunosuppressants, intravenous immunoglobulin, and/or plasma exchange. The total number of treated patients is expected to grow at an annual rate of 1.7 percent.  Of those patients […]

Did you know : that healthcare fraud estimates in the United States exceed $68 billion annually? Did you know : the Federal Government won or negotiated over $2.5 billion in health care fraud judgments and settlements worth a total of over $1.9 billion in FY 2015? Did you know : that when differentiating fraud from waste and abuse, the […]

Are you weighing the decision to enforce an NDC mandate on ALL Medical Pharmacy Claims? RJ Health’s Analytics team shares the pro’s & con’s of NDC mandates across Pricing, Formulary, and Network Quality Considerations. Here are some practical examples to help illustrate how, at the end-of-the-day, RJ Health believes the answer to the NDC vs. […]

On September 14, 2017, the Food and Drug Administration approved the first biosimilar for Genentech’s Avastin® (bevacizumab), which is the first oncological biosimilar product on the U.S. market. Avastin is approved for eight oncological indications, two of which have an orphan drug exclusivity through 2021. The approval of Amgen’s Mvasi™ (bevacizumab-awwb) includes 6 indications (Table […]

In an effort to contain growing healthcare costs, Congress enacted the Omnibus Budget Reconciliation Act of 1990 (OBRA’90) and created the Medicaid Drug Rebate Program. Pharmaceutical manufacturers’ participation in the program became a prerequisite for Medicaid coverage of outpatient prescription drugs. Since then, states have been required to collect associated drug rebates to receive federal […]

A running theme at the Asembia 2017 Specialty Pharmacy Summit was the explosive growth in attendance from several hundred a few years ago to greater than 6,000 in attendance in 2017.  Pharmaceutical and Biological (Pharma/Bio) manufacturers were the dominant presence at Asembia, which is no surprise given their pricing power in the specialty drug market, […]

Gain insight on how your organization can apply modest policy adjustments and some straight-forward network engagement tactics to achieve 6% to 10% in savings on Specialty Drug spend. Take the first step to improving medical drug management controls.

Clinical Drug data, which includes Min Max Dosing, Diagnosis Codes, and Age and Gender data, tends to be overlooked on medical drug claims. Health Plans will primarily analyze and review coding and pricing errors because they are directly connected to pricing and their bottom line. However, clinical errors on claim forms can be just as costly. […]