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Suzanne Tschida, PharmD, Discusses Benefit Design in Specialty Pharmacy Management
Suzanne Tschida, PharmD, vice president, specialty benefits & outcomes, OptumRx, said that at UnitedHealth Group a tiering system is used for the management of specialty medications with a cost-share or copay structure.
Suzanne Tschida, PharmD, vice president, specialty benefits & outcomes, OptumRx, said that at UnitedHealth Group a tiering system is used for the management of specialty medications with a cost-share or copay structure. Since specialty medications tend to have a higher cost-share, Dr Tschida said utilization programs are put in place to help patients stay adherent. ”That’s where we take the approach of appropriate benefit design along with making sure they have appropriate formulary strategies and utilization management programs in place to incent the member to be adherent to their therapy,” said Tschida. Prior authorization, step therapy tiering, and other utilization management programs are all important tools in improving specialty medication adherence as well as lowering costs.
ACA Network Regulatory Filings Are Inaccurate, Poorly Match Provider Directories
September 16th 2025A secret shopper survey (N = 8306) in Pennsylvania’s Affordable Care Act (ACA) Marketplace found inconsistencies between carrier regulatory filings and provider directories, frequent inaccuracies in regulatory filings, and challenges in securing timely appointments.
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Impact of Amivantamab-Lazertinib on EGFR, MET Resistance Alterations in NSCLC: Danny Nguyen, MD
September 15th 2025The combination of amivantamab and lazertinib in first-line non–small cell lung cancer (NSCLC) significantly reduces resistance mechanisms with implications for second-line treatment, said Danny Nguyen, MD, of City of Hope.
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