Vatariri Vanobatsira Mufarisitiri Batsira Kuzadzisa Zvinyorwa Zvako
Imwe maneja anobatsira mishonga (PBM) ikambani inotungamirira, kana inotungamirira, chirongwa chemishonga chemishonga yevashandi vako kana chirongwa chehutano.
PBM yekuita uye kubhadhara zvikwereti zvemishonga zvinongororwa uye zvinokonzerwa nekusika nekuvandudza hurongwa hwako hwehutano hwemishonga yehurumende .
Nemhaka yokuti makambani aya anokwanisa kutenga mishonga yakawanda zvakananga kubva kumakambani emishonga, vanokwanisa kukupa iwe kutengesa maawa mishonga yemishonga .
PBM Is Middleman
Pamwe nzira yakanakisisa yekufunga pamusoro pePBM yakafanana nemunhu ari pakati. Munhu wepakati anobatsira iwe waunoshandira anokuwana iwe rubatsiro rwemishonga uye mishonga yemishonga.
Maererano naAnthem :
Mutungamiri weFarmacy Benefit, kana kuti PBM, isangano rinopa mapurogiramu nemishandirapirwo yakagadzirirwa kubatsira kuwedzera kushandiswa kwezvinodhaka uye zvine zvinodhaka zvinoshandiswa nekushandisa zvinodhaka nenzira yakakodzera kuchinja maitiro ekutsanangura vanachiremba, vanachiremba uye nhengo.
Mitoro yePBMs
Zvinotora basa rakawanda rekugadzirira kuwana mishonga yako kwauri. Nokuda kwekubatsira, PBM inofanira kuzadzisa mabasa akawanda kusanganisira zvinotevera :
- kutaurirana nezvemabhadharo
- shandisa mail mail
- kutarisira kuchengetedza kurwara
- kuita zvinodhaka zvinoshandiswa kudzokorora
- process claims
- kuchengetedza mapurisa
- kugadziriswa kugoverwa pakati pe network of pharmacies
- kupa hutano hwemishonga yemishonga
Sezvaunogona kuona, maPBM ane mabasa akawanda ekuita kuti utarisire.
Muenzaniso wePBMs: CVS / caremark
Imwe yePBM huru munyika iyi CVS / caremark (chikamu cheCVS Health).
Maererano newebsite yeCVS / caremark:
Zvingave nhengo dzeurongwa dzinopinda zvinyorwa zvayo nemishumo kana mune imwe yenhare yedu yenyika inopfuura 68,000 pharmacie dzekutengesa, tinopa rubatsiro uye rubatsiro runodikanwa kuti tione kuti nzira yacho inofamba zvakanaka.
Tinoshanda nevashandirwi, makambani ehutano inshuwarisi, hurumende uye imwe hurongwa hwehutano hwevatsigiri kuronga nekugadzira zvirongwa zvekugadzirisa zvinyorwa. Izvi zvinosanganisira formulary kutungamira, kutengesa kushandiswa kwezvinodhaka zvekutengesa zvinodhaka uye kliniki dzehutano uye kupindira kwehutano.
Kuti PBM, Clinic, Pharmacy uye Tobacco Mutengesi Yakaramba sei
CVS Health ikambani huru, iyo ine ma pharmacy 7800 uye 1000 mini-makliniki pamwe nePBMs. Hazvisi izvo zvinoshamisa here kuti ma pharmacy uye kliniki, iyo inofanirwa kuchengetedza vanhu vane utano, inotengesa zvigadzirwa zvefodya, zvakare?
Muna 2015 TEDX hurukuro, Larry Merlo, CEO weCVS Health, anoti chipikiso ichi chakaita kuti CVS Health iite shanduko nekurega kutengesa zvinhu zvefodya mumafarisi avo muna February 2014.
Nokudzivisa kutengesa fodya, Merlo anoti kambani yake "yakabva" kubva ku $ 2 biliyoni mukutengesa. Merlo anotenda kuti kuburikidza nekudzikisa kusvika kune zvigadzirwa zvefodya, vanhu vachabva vasvuta zvishoma uye vanotsvaga dhesi kuti vatsigire izvi zvinotaurirwa. Maererano naMerlo, mumwedzi mushure meCVS dzisiri kurega kutengesa fodya, yakaona vanhu vane mamiriyoni vanoda kurega kusvuta mumakiriniki avo uye vakagadzira purogiramu huru yekurega kusvuta. Uyezve, chisarudzo chekurega kurega kutengesa fodya chakanga chisina kukanganisa kutengesa.
Zviripo zvakagadzirirwa naNaveed Saleh, MD, MS, musi wa31/31/2016.
Sarudzo Sources
TEDx hurukuro na Larry Merlo musi we4/7/2015