How can USI help our organization exercise closer management of our pharmacy benefit utilization?
USI recommends establishing appropriate quality limits for all prescription drug classes to reduce the potential for fraud, waste, and abuse.
Establishing appropriate quantity limits for prescription drugs can lower pharmacy benefit costs by 2% to 5%.
We’ve estimated the financial impact for you. Feel free to update the assumptions.
- Reduces opportunities for fraud and potential abuse
- Ensures member adherence to prescription drug regimens
- Partial or "split" filling for 15-day supplies for high-cost drugs limits exposure to waste due to clinical ineffectiveness
Pharmacy costs represent 20% to 30% of most total employer-sponsored health benefit plan costs. Additionally, pharmacy benefit managers’ automatic refill programs dispense more prescription drugs than are needed, which can lead to waste and an excess supply of up to 35%.
Prescription opioid drugs remain the primary pharmaceutical driver of patient abuse, fraud, and health risks. Opiod abuse is considered a public health emergency. Data has shown that opioid abusers incur twice the health care expense as non-abusers. However, the rise GLP-1 weight loss should also have closely monitored quanity limits due to the health and saftey risks they pose to plan members, as well as the high cost of these drugs.
In addition to partial or "split" prescription fills, USI recommends 30-day supplies for specialty prescriptions, rather than 90-day supplies.
I’d like to explore further how USI can help our organization exercise closer management of our plan participants’ pharmacy benefit utilization.
To assess your pharmacy plan's existing prescription utilization management strategies we will need just a few pieces of information including your pharmacy plan design, a utilization report of pharmacy claims, and a recent pharmacy audit, if available.