Laboratory Benefit Managers

05/13/24 • 2 min

Petauri PACT Executive Briefings - 3-Minute Market Insights

Laboratory Benefit Managers have emerged over the past decade to fill the need to manage complex and expensive laboratory testing for payers. They have become the new Precision Medicine Gatekeepers.

Results from over 14 billion diagnostic tests are estimated to influence 70% of today’s clinical decisions. It’s estimated that there is both overutilization of testing in approximately 20% of cases, and underutilization of testing in approximately 45% of cases. Laboratory Benefit Managers have improved Next Generation Sequencing test payment turnaround times, but also have increased denial rates.

You can download the full Executive Briefing at: https://tkgpact.com/executive-briefings/

Or, feel free to email us at [email protected]

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Laboratory Benefit Managers have emerged over the past decade to fill the need to manage complex and expensive laboratory testing for payers. They have become the new Precision Medicine Gatekeepers.

You can download the full Executive Briefing at: https://tkgpact.com/executive-briefings/

Or, feel free to email us at [email protected]

Previous Episode

Barriers to New Therapy Adoption: Therapeutic Inertia

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The term therapeutic inertia describes the failure of health care providers to initiate or intensify therapy when it is clearly indicated by established guidelines. The term has largely been applied to the management of blood pressure, blood sugar, and cholesterol, by primary care physicians who recognize the need for their patients to control these conditions but fail to act sufficiently to achieve the guideline recommended therapeutic targets. Despite clearly articulated, evidence-based, clinical guidelines, some physicians fail to translate this knowledge into practice. We believe that therapeutic inertia plays a significant role in delaying the adoption of many new treatments.

Most practitioners function within a “personal comfort zone” of prescribing behavior, being reluctant to take unnecessary risks with new drugs. There is a natural “learning curve,” where clinicians need to learn the side effect profiles and characteristics of new drugs, as well as to be assured that the drugs perform as promised.

You can download the full Executive Briefing at: https://tkgpact.com/executive-briefings/

Or, feel free to email us at [email protected]

Next Episode

Understanding the “bagging” of Patient Medications

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When a physician prescribes an expensive specialty medication for a patient, the traditional distribution process was for the provider to purchase the medication, administer it to the patient, and then bill the insurance company for the drug. This “buy-and-bill” process has been utilized for many years.

In recent years, and to help control costs, third-party payers have mandated that the medications come from their own pharmacies where they have more control over the acquisition price of the drugs. This is especially prevalent for expensive, specialty pharmaceuticals.

Various alternatives of this approach have been referred to as “bagging”. In this episode, we define the different types of "bagging" that you may be hearing about.
You can download the full Executive Briefing at: https://tkgpact.com/executive-briefings/

Or, feel free to email us at [email protected]