News

PAI is expanding its partnership with Smart Data Solutions (SDS) for AI- and automation-driven clearinghouse services, marking a significant milestone in our collaboration. The new end-to-end clearinghouse and EDI gateway solution, with the AI- and

In 2023, PAI welcomed a large dental carrier to our book of business. With a quick implementation timeline and stringent carrier requirements, PAI was able to adeptly move all hands on deck to provide streamlined service to the carrier’s 25,000

This month PAI won HR Tech Magazine's Top Employee Benefits Service Provider for 2024. We received this recognition because of our flexible benefit designs, competitive rates, stellar customer service, and dedication to our clients. Our model — the

The changes in this bulletin apply to all groups that use OptumRx Lowest Net Cost (LNC) Formulary. These changes include decisions that occurred as a result of our November 2023 Pharmacy and Therapeutics Committee (P&T) meeting. Members negatively impacted by one of these changes will be sent a letter in February.

Greenwich, Conn. – Cedar Gate Technologies’ Healthcare Benefits Analytics is helping Planned Administrators, Inc. (PAI) better address the needs of its brokers, account managers, stakeholders, and client groups managing over $644 million in billed charges. The self-service analytics software provides streamlined, automated reporting and critical access to member data to help the program – which their users know as PAI Analytics – address rising costs and care quality for their populations.

Recently, three pharmaceutical manufacturers announced significant pricing changes to their insulin products in response to regulatory and industry factors stemming from implementation of the American Rescue Plan Act of 2021, along with changes made to eliminate the Medicaid Rebate Cap starting January 1, 2024. While this change will result in a price decrease for these products to members, manufacturer rebates to the health plan will also decrease, or be eliminated. However, the pricing change will also result in a similar decrease in the cost of claims to the plan.

The changes in this bulletin apply to all groups that use OptumRx Lowest Net Cost (LNC) Formulary. These changes include decisions that occurred as a result of our September 2023 Pharmacy and Therapeutics Committee (P&T) meeting. Members negatively impacted by one of these changes will be sent a letter in November.

The PAI Marketing team entered four pieces to the 2023 MarCom awards and came out with two gold wins. MarCom Awards is an international creative competition that recognizes outstanding achievement by marketing and communication professionals. Entries

Seasonal Preventive Flu Vaccines Members with PAI pharmacy benefit coverage with OptumRx can get flu vaccines covered under their pharmacy benefit at any in-network pharmacy. Flu vaccines administered by network pharmacies are subject to an administration fee that will be the group’s responsibility. Members are responsible for the full cost of the vaccine administered in out-of-network pharmacies.

To support appropriate utilization management, we continually review relevant clinical guidelines and reassess our requirements. Utilization management criteria for Freestyle and Dexcom CGMs will be updated for some of our formularies effective September 11, 2023.