Most plans have a precertification process in place for high-dollar drugs that addresses the appropriateness for diagnosis as well as provider network status; however, this is where it stops.
Read moreAre You Ready? Preparing for Gene and Cell Therapies Coming Down the Pipeline
Gene and cell therapies can be life changing but come with expensive price tags. As more therapies are FDA approved, payers are looking for options to control the spiraling cost of specialty pharmacy and to project future financial risk related to new therapies coming to market.
Read moreDisclosure and Insurability
One of the crucial steps in finalizing reinsurance coverage is disclosure. When preparing a quote, the reinsurer performs a careful analysis of reinsurance claim costs and trends, including an analysis of the current year's activity. A critical assumption is the degree to which this data can be considered complete. Disclosure helps the reinsurer solidify the accuracy of this assumption.
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