Author name: Sean Newton

When navigating insurance complexities—especially with specialty medications—a Benefits Investigation (BI) is essential. It’s more than just a formality: it’s a critical part of your pre-service process that helps avoid costly surprises for both patients and providers. What Is a Benefits Investigation (BI)? A benefits investigation is a detailed review of the patient’s insurance plan—medical or pharmacy—to determine: It’s often mistaken that a prior authorization alone is enough. However, without a thorough benefits check, even an authorized service may result in denials or unexpected costs. We recommend combining all verification steps—benefits check, prior authorization, and eligibility—into a comprehensive Pre-Service Review for full clarity and risk reduction. Why It Matters You’ve likely heard this disclaimer before when calling an insurance provider: “This information is a quote of benefits and is subject to the patient’s coverage at the time of service.” It may sound like legalese, but it’s an important reminder: Policies change. Life changes. Patients may switch employers, update coverage, or face new eligibility restrictions. Best practice: verify insurance and eligibility before each visit and for each service offered. This protects your patients from unexpected bills and protects your practice from reimbursement losses. Step-by-Step: Conducting a Benefits Investigation ✅ Step 1: Identify the Insurance ✅ Step 2: Confirm the Service or Therapy ✅ Step 3: Prepare Required Information 📋 Key Eligibility Questions to Ask 💡 Benefit-Specific Questions (by CPT/HCPCS Code): Medical vs. Pharmacy Benefit: What’s the Difference? Understanding whether a service or medication is covered under the medical or pharmacy benefit can affect: 🏥 Medical Benefit Overview Also known as “Major Medical,” this covers services delivered in-office or at an outpatient facility. 💊 Pharmacy Benefit Overview Used when patients self-administer medication or receive it via pharmacy-delivered methods (oral, auto-injector, topical, etc.). 💡 Pro Tip: Medical vs. Pharmacy Impacts Dispensing Whether a drug is billed under the medical or pharmacy benefit depends on: 🧾 Copay Cards & Accumulator Programs When affordability is a concern, don’t overlook: ✅ Final Thoughts A benefits investigation is not optional—it’s essential. It ensures: By turning benefits verification into a structured, repeatable process, your team can support patients more effectively and reduce financial risk for your practice.

Are you trying to eat better, move more, or cut back on unhealthy habits—but struggling to stay consistent? You’re not alone. Changing habits takes time, effort, and patience. But the payoff can be life-changing—improving your energy, preventing chronic disease, and helping you feel your best every day. Below, we walk through the four key stages of behavior change and offer practical tips to help you build healthy habits that stick. The Four Stages of Changing a Health Habit Stage 1: Contemplation – Thinking About Change At this stage, you’re considering a healthier lifestyle but haven’t committed yet. Maybe you believe it will help your energy or reduce your risk of disease, but you’re unsure how to start. 🔎 Reflect: 📝 Example Pros and Cons: Healthy Eating✔ More energy, better health, proud of my choices✖ Costs more, need to cook at home, change family habits Physical Activity✔ Stronger, more energy, stress relief✖ Time-consuming, self-conscious, unsure what to do Stage 2: Preparation – Getting Ready to Act You’ve decided to make a change—great! Now it’s time to plan and set clear, achievable goals. 🧠 Tips for Success: Example Goal:“I’ll walk for 10 minutes after dinner, 3 times a week.” Stage 3: Action – Putting Plans Into Motion You’ve started making real changes. Whether it’s choosing healthier meals or becoming more active, this stage is all about momentum. ✅ Tips to Stay on Track: 📊 Bonus: Use free tools like the NIH Body Weight Planner to track activity and eating goals. Stage 4: Maintenance – Making It a Lifestyle After six months of consistent changes, your new habits are becoming part of your routine. 💡 Keep Things Fresh: 🧪 Clinical Trials: Get Involved in Research Want to contribute to medical discoveries? Clinical trials help advance science and improve care for others. Final Thought Changing habits isn’t about perfection—it’s about progress. Wherever you are in your journey, remember: small, consistent steps lead to lasting results.

Specialty pharmacy has always held the promise of delivering high-touch, patient-centered support—especially for those with chronic or complex conditions. But in reality, the system often falls short. The Reality Gap: Where Traditional Specialty Pharmacy Falls Short Despite good intentions, today’s model is fragmented and frustrating—for both patients and care teams. From delayed therapy starts to overwhelming costs and administrative burden, the system too often fails to deliver the seamless experience it promises. Medically Integrated Dispensing: A Better Path Forward MID centers the care model around the patient, integrating pharmacists as core members of the medical team. Rather than placing the burden on patients to manage their treatment journey, MID empowers the care team to take the lead. The Pharmacist’s Role in MID In this model, pharmacists actively support the care journey: This hands-on involvement creates better outcomes and restores the true purpose of specialty pharmacy. Why Technology Matters The success of MID depends on one critical piece: seamless information sharing. With the right tech, pharmacists and providers can: This integrated approach turns a fragmented system into a connected care experience. Conclusion: Fulfilling the Promise of Specialty Pharmacy Medically Integrated Dispensing isn’t just a new model—it’s a return to what specialty pharmacy was always meant to be: collaborative, high-touch, and patient-first. With the right people, processes, and technology, we can restore that promise—together.