Articles tagged with “utilization-management”

Drug Formulary Tiers Explained: Step Therapy vs. PA Guide

Learn what drug formulary tiers are and how they affect prescription costs. Updated for 2026 with CMS-0057-F ePA rules, gold card laws, and IRA drug cost caps.

45 min read

11/7/2025

drug formulary formulary tiers step therapy prior authorization utilization management prescription drug costs medication adherence health insurance

Cohere Health: AI in Prior Authorization & Company Profile

Learn about Cohere Health, the health-tech firm using AI to automate prior authorization. Updated for 2026 with ZignaAI acquisition, record growth, and expanded platform coverage

25 min read

11/5/2025

cohere health prior authorization utilization management ai in healthcare clinical intelligence health tech payer solutions ai

Understanding Drug Formularies, Benefits, and ePA in the US

An in-depth guide to US drug formularies, pharmacy benefits, and prior authorization (PA). Learn how P&T committees, tiers, ePA systems, and the CMS-0057-F interoperability rule shape drug coverage and costs

50 min read

11/2/2025

drug formulary pharmacy benefits utilization management p&t committee managed care pharmacy benefit manager us healthcare