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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