Category Archives: Industry Insights

Beginning April 29 and continuing to May 2, Asembia will be hosting its 15th annual Specialty Pharmacy Summit at Wynn & Encore in Las Vegas. RJ Health is excited to join the many pharmacies, health systems, pharmaceutical manufacturers, PBMs, health plans, technology companies, and consulting firms that will be in attendance. The agenda includes continued […]

INSIDE THIS ISSUE CMS News New HCPCS® C-Codes Effective April 1, 2019 Now Available Quarterly ASP (Average Sales Price) Pricing File Revised for April 2019 April 2019 NOC (Not Otherwise Classified) Pricing File Hospital OPPS (Outpatient Prospective Payment System) Update Drug Reimbursement Code Price Updates Drugs/Devices New Clinical and Billing Information Software Updates Prioritize your […]

In March there were three new drug approvals by the FDA we deemed specific to the specialty market. In addition, there were four supplemental drug approvals. The FDA had acted on the assignment of new PDUFA dates for ten new products for review. Finally, there was one product that had an extension of a PDUFA […]

Our latest white paper demonstrates the value and versatility of an automated medical drug claim edits solution. RJ Health’s system implements a rules-driven platform to reduce overall medical drug claims errors and improve overall efficiency. Appropriate reimbursement for drugs covered by the medical benefit increasingly requires more data and structure. Many of the billing systems […]

As drug spend increases, so does the use of genetic tests. How does this affect claims processing? Watch to learn more: VIEW THE FULL WEBINAR [TRANSCRIPT] So, the next question that we often hear from our clients is great, don’t need to worry about this on the pharmacy benefit, medical benefit, so what we did […]

INSIDE THIS ISSUE CMS News Drug Reimbursement Code Price Updates Drugs/Devices New Clinical and Billing Information Software Updates Prioritize your Code Level Pricing CODE UPDATES Large Price Changes: We identify and report on the codes with the most substantial pricing increases or decreases each month and detail the rationale for the change. Of the 35 […]

Of about clinical 1,400 studies, 34% were tied to some sort of genetic test. This will only increase over time. Watch to learn more: VIEW THE FULL WEBINAR   [TRANSCRIPT] Now, the other piece is, okay, great, so we have these 27 products, pretty small compared to the hundreds or thousands of products that we’re […]

In February there were two new drug approvals by the FDA we deemed specific to the specialty market. In addition, there were two supplemental drug approvals. The FDA had acted on assignment of new PDUFA dates for three new products for review. Finally, there was one complete response letter issued. Drugs included in this review […]

Today there are 27 drugs that have been approved by the FDA that have genetic companion diagnostics tied to them. Genetic-defined therapies are becoming more prevalent in many cases. Although not the case with every therapy, there is definitely a trend with drugs requiring genetic tests having a higher cost per treatment. Watch to learn […]

INSIDE THIS ISSUE CMS News: Home Infusion Therapy (HIT) Administration Codes are now Available Drug Reimbursement Code Price Updates: We review the reimbursement HCPCS/CPT® Codes in our system Drugs/Devices: New Clinical and Billing Information Software Updates: How to Locate a Drug Monograph CODE UPDATES Large Price Changes: We identify and report on the codes with […]