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,
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.
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.