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Prescription Drug Claims Review and Analysis |
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Your prescription drug claim data is an
invaluable tool for understanding your current situation
and predicting the future. It can provide insights about
the changes necessary to meet your goals. But data is useless
unless you know exactly what you’re looking at and
what are reasonable alternatives for your particular group.
PBM reports are often unreliable, confusing or presented
in a skewed manner.
Associates & Wilson is experienced
in data review. We’ll help you identify which drugs
are available alternatives for your most frequently dispensed
drugs, what sorts of claims members are making and what
illnesses seem to effect them more today than last month,
last year, last decade. Associates & Wilson looks for
patterns that indicate fraud, abuse, inappropriate coverage
and substandard patient care including:
- High number of brand prescriptions when high quality
generics are available
- Prescriptions being filled in quantities or for periods
of time that far exceed best practice guidelines or expected
prevalence of claims
- High number of prescriptions for drugs that are often
used for cosmetic, experimental or lifestyle purposes.
Once the problems and the opportunities
begin to emerge from the routine data analysis, data is
further evaluated. As information gets more specific, the
best solution becomes obvious.
Our “Sparks” service uses your
experience and utilization to spark ideas for health management
initiatives. By staying ahead of the curve, you avoid costly
mistakes that then have to be corrected. Well-planned initiatives
can be implemented before the situation turns into a crisis.
This process saves both time and money. Associates &
Wilson can help you understand your numbers and develop
strategies to manage your claims based on this information.
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