Antidepressants for alcoholism, oral contraceptives for menstrual disorders, stimulants for weight loss; all of these are examples of off-label drug prescription use. It's a common practice, but is it safe or is it misuse or even abuse? The answer is, that depends.
There are three common myths circulating in the employer benefits marketplace regarding prior authorization (PA) services:
- All PA Programs are the same.
- My PBM won’t let me.
- It’s too confusing for members.
In this article, we’ll explore and dispel those myths and provide
a glance at the value of carving-out these programs from the pharmacy benefit management contract. Successful PA programs, when managed effectively, are the gatekeeper to controlling soaring pharmacy expenditures while ensuring the right patient gets the right drug in the right dose at the right time.
Topics: High Cost Medications, Controlling Pharmacy Expenditures, pharmacy spend, Coverage Determination Process, Prior Authorization, Specialty Drug Cost Control, Prior Authorization Processing, health plan management, population health, healthIT, data accessibility, patient outcomes,, drug costs,, rising drug costs,
It’s an inescapable truth that, in healthcare, data matters. For health information technology innovators, data is the window inside a lifecycle of a service, product, or application that can be analyzed for improvement. For providers, data helps the accuracy of diagnoses and creates more effective treatment paths. Health plans benefit from data as well. For plans, data builds actionable information and insights, two important steps in the balance of managing risk for each plan and enhancing outcomes for each member.
Health plans need access to information sources that help build for the future. But this need goes beyond simply connecting to the traditional repositories that capture and store large amounts of information. To optimize our understanding of users, patients, and members, plans must have access to sources beyond claims data. Expanded data sets from non-traditional sources will benefit plans with the right tools to manage collection and analysis.
One such non-traditional, underutilized source is prescription drug monitoring program (PDMP) data. Since the adoption PDMPs, these electronic database systems have amassed a decade’s worth of information regarding prescribing and dispensing behaviors of controlled substances as well as information that can be used to develop baselines for analysis or to monitor trends. There is an industry-wide need to make PDMP data accessible, building towards the goal of creating outcomes-based healthcare.
Building upon current frameworks of data sharing and utilization, we identify the opportunities in which PDMP data can help health plans in the future.