In the second half of a two-part episode on PBMs, experts Marc A. Sweeney, Trevor Daer and Mike Kroupa return to discuss some of the intricacies of the pharmaceutical industry. They tackle complex topics like international drug sourcing, specialty drugs, GLP-1s and more.

There are several key vendor decisions brokers and plan sponsors must make when unbundling a self-funded health plan, including pharmacy benefit management. On a new episode of ClaimTalk, self-funding experts Marc Sweeney, Trevor Daer and Mike Kroupa will help you evaluate if you're making the best decision on your drug spend.

BUCAs may seem like the easy, all-inclusive choice, but they don’t offer the personal, one-on-one assistance most health plan members actually prefer. Plus, no plan sponsor should accept inferior member service — whether big network or reference-based pricing. In this month’s episode of ClaimTalk, Michelle Henaman and Heidi Martinez share the gaps in service you need to DEMAND get filled for your clients.

In this month's episode of ClaimTalk, brokers and industry experts Craig Gottwals and Mike Kerns are back for ADVISORS UNLEASHED — Part 2. They go even deeper into the benefits consulting industry, offering more brutally honest insights you won't hear anywhere else.

This month's edition of ClaimTalk is the first half of a two-part discussion with brokers and industry experts Craig Gottwals and Mike Kerns. They provide an inside look at the benefits consulting industry in a no-holds-barred conversation you won't want to miss.

Access will always be an obstacle with RBP medical plans. At ClaimDOC, we believe obstacles can be overcome. Our first wave of attack is proactive provider education through Pave the Way. When that’s not working, we turn to Austin Miller and our team of fixers. Learn more about Austin's journey at ClaimDOC and how our provider relations team uses data and relationships to ensure access in a new episode of ClaimTalk.

As a fiduciary, you are responsible for ensuring medical claims are billed accurately. If your plan administrator is prevented from auditing claims due to the network contracts, who is fulfilling this duty? Cynthia Swanson and Amy Pellegrin join this month's episode of ClaimTalk to discuss egregious billing practices and what it is required to be a compliant fiduciary. 

How do you silence RBP noise? In this month's episode of ClaimTalk, we interview rock star member advocate Amanda Ogg, and our training manager, Lori Van Groningen, about how they approach the challenges facing our members. There would be no headache-free direct access to care or cute baby pictures without their efforts.

Direct contracts are very different from direct access. In our latest episode of ClaimTalk —Winning the RBP Access War, With or Without Contracts — two of our legal experts share how we interact with providers to make sure DirectAccess+ members can receive medical care when they need it and from whom they want to receive it.

Is the member experience too challenging with reference-based pricing programs? Listen to Bruce and Stephanie discuss the challenges our member advocates face each day as they help members navigate their medical plans. And hear about the successes they achieve directly from one of our member advocates.