A pharmacy insurance process expert witness is a highly specialized professional who provides expert testimony in legal cases involving pharmacy insurance claims and related issues. They possess deep knowledge of the intricate workings of pharmacy insurance plans, including:
- Claim adjudication: The process by which insurance companies determine whether to pay for a prescription drug claim.
- Formulary management: The criteria used by insurance companies to decide which drugs are covered under their plans.
- Prior authorization: The requirement for certain medications to receive approval from the insurance company before they can be dispensed.
- Pharmacy benefit managers (PBMs): Third-party companies that manage prescription drug benefits for insurance companies.
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