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: 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
According to United Health Center for Health Reform and Modernization the United States spent $87 billion on specialty drugs in 2012, and that number is estimated to reach $400 billion by 2020. In 2014 alone the cost of specialty products alone has risen 13.1%. Specialty drugs now cost more than the median household income.