Understanding Pharmacy Utilization Patterns

Pharmacy benefits continue to increase as a percentage of overall plan cost from year to year. In order for pharmacy costs to continue to grow and increase its share of the overall health spend, they must routinely outpace medical expense trend and occupy spaces once reserved for medical expenses. All of this means that it is no longer sufficient to shop pharmacy benefits for the best discount off average wholesale price. We must observe study and understand the utilization patterns of pharmacy benefits.

Educational Services Company has been successful in monitoring these utilization patterns and investigating anomalies to identify abuse, misuse and plan design flaws. In this case, we identified an inordinate number of strong opiate/opioid medications filled given the size of the group and the known large claim diagnoses. After we presented this data to the client, we were given permission to explore this issue further. Ultimately, we discovered that there was a combination of abuse, misuse and poor plan design. We were able to address each of the problems while always maintaining confidentiality and the highest level of decorum. The plan design was altered to deter those with nefarious motives while maintaining ease of access for patients with medical necessity.

The client was extremely happy that this problem was identified and addressed. They felt strongly that the savings went far beyond the cost of abuse and misuse and that there would be positive results in presentism, absenteeism and overall culture. For additional information regarding your plan, please call Educational Services Company at 317-818-3535.

For more information on understanding pharmacy plans, please call us at 317-818-9535 or submit your contact information below.