Smarter Decisions, Superior Outcomes

Managing Trends and Prescribing of Orphan Drugs

Posted by Kathleen Sabo on April 10, 2018 at 1:11 PM

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The development of orphan drugs, those used for the safe and effective treatment, diagnosis or prevention of genetic and rare diseases or disorders, is on the upswing.

In the past five years, 61 orphan drugs were approved. This is the largest for any five-year period since 1983, when Congress passed the Orphan Drug Act, a measure that gives financial incentives to encourage companies to develop drugs and biologics for rare diseases. The legislation includes tax credits to defray the costs of clinical trials and provides for fast-track FDA approval and market exclusivity. It's important because, before its passage, drug companies were weighing the financial viability of researching and developing these drugs. The Orphan Drug Act led to the development of hundreds of new drugs to treat a variety of conditions.

With orphan therapies on the rise, more people with rare diseases and genetic disorders have more treatment options designed to help them lead healthier, more productive lives.

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Topics: specialty drug pipeline,, rising drug costs,, patient outcomes,, drug costs,, population health, health plan management, pharmacy spend, orphan drugs, High Cost Medications

Managing Off-Label Prescribing in your Pharmacy Benefit

Posted by Kathleen Sabo on February 21, 2018 at 9:00 AM

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.

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Topics: FDA drug approvals, patient outcomes,, population health, health plan management, opioids, Prior Authorization Processing, Coverage Determination Process, Prior Authorization

3 Common Myths about Prior Authorization Carve-Out

Posted by Kathleen Sabo on February 15, 2018 at 10:49 AM

There are three common myths circulating in the employer benefits marketplace regarding prior authorization (PA) services:

  1. All PA Programs are the same.
  2. My PBM won’t let me.
  3. 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 pharma
cy 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.

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Topics: rising drug costs,, drug costs,, patient outcomes,, data accessibility, population health, health plan management, pharmacy spend, High Cost Medications, Prior Authorization Processing, Controlling Pharmacy Expenditures, Specialty Drug Cost Control, Prior Authorization, Coverage Determination Process, healthIT

Why Health Plans Need PDMP Data

Posted by Denika Hockenhull on May 2, 2016 at 9:00 AM

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.

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Topics: pharmacy spend, opioids, prescription drug monitoring, PDMP, health plan management, controlled substances

Independent & Objective

Clinical expertise without the noise

Getting the facts matters. Following our corporate mission, we're committed to using this blog to enhance your knowledge of evolutionary events and discussions in the pharmacy services and technology arena. 

Here's what we're focused on right now:

  • Lowering ingredient cost
  • Enhancing the coverage determination process
  • Creating robust prior authorization criteria
  • Producing actionable drug trend analyses
  • Enhancing prescription drug monitoring 
  • Implementing interoperability efforts

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