GHAPPcast: Payer Tutorial
GHAPPcast16 Syys 2025

GHAPPcast: Payer Tutorial

In this podcast, pharmacist Jeffrey Dunn and Dr. Ed Pezalla boil down how U.S. managed care really works—covering Medicare, Medicaid, and commercial insurance, the difference between self-insured vs. fully insured risk, and how PBMs and health plans split responsibilities across the pharmacy vs. medical benefit. You’ll learn why formularies, prior authorizations, step therapy, and utilization management exist, how to navigate them, and what to check on the back of the insurance card before you start a PA. The conversation offers a practical playbook for clinics: map your region’s top payers, gather their PA criteria and forms, document the right clinical data up front (the #1 cause of denials is missing information), and build working relationships with payer teams. They also touch on the impact of specialty drug costs, biosimilars, and the growing role of technology/AI in streamlining approvals—all aimed at aligning outcomes, patient experience, and cost.

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Jaksot(154)

Medication Review: Guselkumab IV vs SC Formulation

Medication Review: Guselkumab IV vs SC Formulation

Thank you to Johnson & Johnson for their support on this Medication Review Video Module. In this quick educational video, Angelina Collins, NP, from the University of California San Diego Inflammatory...

28 Touko 3min

FAQ: Recognizing OHE Risk in Patients with Chronic Liver Disease

FAQ: Recognizing OHE Risk in Patients with Chronic Liver Disease

Thank you to Salix for the support on this FAQ Video Module.This educational FAQ module, featuring Mikhail Alper, PA-C focuses on recognizing risk factors and early clinical indicators of Overt Hepati...

26 Touko 2min

FAQ: Phase 3 GALAXI 2 & 3: Extraintestinal Manifestations In Moderate to Severe Crohn’s Disease

FAQ: Phase 3 GALAXI 2 & 3: Extraintestinal Manifestations In Moderate to Severe Crohn’s Disease

Thank you to Johnson & Johnson for the support on this FAQ Video Module.This FAQ video features Janette Villalon, PA, who reviews the role of guselkumab in treating extraintestinal manifestations in p...

19 Touko 5min

Medication Review: Monotherapy vs. Combination Therapy: Relevance in IBD Treatment Strategy

Medication Review: Monotherapy vs. Combination Therapy: Relevance in IBD Treatment Strategy

Thank you to Celltrion for the support on this Medication Review Video Module.This medication review explores the evolving role of monotherapy versus combination therapy in the treatment of inflammato...

14 Touko 3min

Medication Review: Stable PK Supporting Continuous Inflammatory Control

Medication Review: Stable PK Supporting Continuous Inflammatory Control

Thank you to Celltrion for the support on this Medication Review Video Module.This medication review explores the role of stable pharmacokinetics (PK) in achieving continuous inflammatory control in i...

7 Touko 6min

Journal Club: ASTRO Phase 3 Study: Efficacy and Safety of SC Guselkumab

Journal Club: ASTRO Phase 3 Study: Efficacy and Safety of SC Guselkumab

Thank you to Johnson & Johnson for the support on this Journal Club Review Module.In this journal club video, Sharon Dudley Brown, CRNP, PhD, from the IBD Center at Johns Hopkins University, reviews t...

28 Huhti 5min

Journal Club: Benefit–Risk Profile of Upadacitinib in Patient’s With Moderate to Severe UC and CD

Journal Club: Benefit–Risk Profile of Upadacitinib in Patient’s With Moderate to Severe UC and CD

Thank you to AbbVie for the support on this Journal Club Review Module.This journal club review episode explores the benefit–risk profile of Upadacitinib for patients with moderately to severely activ...

21 Huhti 23min

Podcast: How Do You Best Support Patients Getting Started on New MASH Treatments?

Podcast: How Do You Best Support Patients Getting Started on New MASH Treatments?

Learn how to effectively support patients starting treatment for MASH with this practical, clinician-focused discussion featuring expert advanced practice providers. In this episode, hepatology specia...

14 Huhti 18min

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