GHAPPcast: Payer Tutorial
GHAPPcast16 Sep 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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Avsnitt(161)

GHAPPcast: Recognizing and Managing Overt Hepatic Encephalopathy

GHAPPcast: Recognizing and Managing Overt Hepatic Encephalopathy

Thank you to Salix for their support on this podcast episode. In this GHAPP podcast, host Christina Hanson, FNP, welcomes Janet Gripshover, DNP, FNP-BC, MBA, for a practical discussion on recognizing ...

18 Aug 48min

FAQ: Counseling Patients on Overt Hepatic Encephalopathy

FAQ: Counseling Patients on Overt Hepatic Encephalopathy

Thank you to Salix for their support on this FAQ video module.In this FAQ video module, Natalie Oliver, PA-C, discusses how healthcare professionals can counsel patients and caregivers about overt hep...

11 Aug 4min

FAQ: Identifying & Diagnosing Overt Hepatic Encephalopathy

FAQ: Identifying & Diagnosing Overt Hepatic Encephalopathy

Thank you to Salix for their support on this FAQ video module. In this FAQ video module, Samantha Ramirez, NP-C, discusses how healthcare professionals can identify and diagnose overt hepatic encephal...

4 Aug 2min

Subgroup Analysis: Differences in Maintenance Dosing For UC and CD

Subgroup Analysis: Differences in Maintenance Dosing For UC and CD

Thank you to Johnson & Johnson for their support on this podcast episode. In this GHAPP podcast, Amy Stewart, NP, of Capital Digestive Care, introduces a practical inflammatory bowel disease discussio...

23 Juli 7min

Medication Review: Efficacy & Safety of Risankizumab in Patients with Moderate to Severely Active UC

Medication Review: Efficacy & Safety of Risankizumab in Patients with Moderate to Severely Active UC

Thank you to AbbVie for their support of this Medication Review Video Module.In this medication review, Melissa Ferrari, PA, and Jennifer Hamilton, MSPAS, PA-C, provide a comprehensive overview of the...

30 Juni 17min

Med Review: SEQUENCE Trial: Risankizumab vs Ustekinumab in Anti-TNF-Refractory Crohn’s Disease

Med Review: SEQUENCE Trial: Risankizumab vs Ustekinumab in Anti-TNF-Refractory Crohn’s Disease

Thank you to AbbVie for their support on this Medication Review Video Module. In this medication review, Sharon Dudley-Brown, CRNP, PhD from Johns Hopkins University and Angelina Collins, MSN, ANP-BC,...

9 Juni 12min

FAQ: QUASAR Long Term Extension Interim Analysis

FAQ: QUASAR Long Term Extension Interim Analysis

Thank you to Johnson & Johnson for their support on this FAQ Video Module. In this educational video, Jamie Brogan, APRN, from Northwestern Medicine, reviews the latest QUASAR long-term extension data...

2 Juni 4min

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 Maj 3min

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