Smarter Decisions, Superior Outcomes

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.

Read More

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

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.

Read More

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,

How Formularies Make an Impact

Posted by Denika Hockenhull on September 29, 2016 at 9:05 AM

Over the past few years, prescription drug costs have risen in a dramatic fashion. According to a federal report released this spring, prescription-drug spending rose 12.6% in 2014 and spending is expected to rise 7.3% a year through 2018. The increased cost is most closely associated with the influx of specialty drugs—high-cost prescription medications used to treat complex, chronic conditions. Rather than offset these prices, generic drugs costs are also experiencing an increase in price adding to the prescription drug cost burden. Drug utilization and the increasing cost of prescription drugs for members who require these medications as maintenance therapy is constantly in the forefront of discussion.

Read More

Topics: patient outcomes,, drug costs,, formulary,

Balancing Effectiveness and Cost of Specialty Medications for Treating Complex Conditions

Posted by Denika Hockenhull on June 1, 2016 at 10:00 AM

Spending on specialty pharmaceuticals climbed 18 percent in 2015, compared to an increase of less than 1 percent for standard prescription medications. The burgeoning outlay comes as no surprise considering the hefty price tag of these new drugs, with some reaching upwards of $60,000 for a course of treatment.

Read More

Topics: pharmacy spend, Specialty Drug Cost Control, Specialty Drug, patient outcomes,, biosimilars, interchangables,, drug costs,, rising drug costs,

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

Subscribe to Email Updates

Recent Posts