Preferred Drug List Development
Essential to EBRx, Preferred Drug List development is a two step review process.
The first step is a comprehensive scientific review of medications available to treat a particular condition. The purpose is to identify whether one or more agents are proven superior to other comparable agents, or whether all available medications in a category are clinically equivalent. The scientific review also highlights safety concerns about mediations and their use in certain patient subsets.
The second step is to aggressively negotiate the lowest cost available for superior medications, or to select the least costly alternatives when there are no significant differences among treatment options. The end result is a Preferred Drug List which offers the most proven medications at the lowest possible cost to the employee and the payor.
The benefits of an evidence-based PDL are clear; you as the payor provide coverage only for medications with proven clinical value. When multiple medications are judged equal in a therapeutic class, selection of the preferred drug is based on the most economical choice.
In addition to creation of a PDL, EBRx can assist in establishing methods, such as tiered co-payments and prior authorizations, to encourage appropriate prescribing and dispensing of medications on the PDL.
Drug Utilization and Review (DUR) Functions
EBRx pharmacy and medical staff can analyze medical and pharmacy claims to identify aberrant patterns of drug utilization. Such analysis can identify underutilization of medications known to reduce overall costs and improve health outcomes, as well as overutilization of medications with limited or no clinical value. Appropriately executed Drug Utilization and Review activities can identify opportunities to educate employees and health providers on specific disease states and medication issues. Drug Utilization and Review activities can help to avoid adverse events for individuals by promoting compliance with the most appropriate therapies for their medical conditions.
EBRx Prior Authorization (PA) Call Center
The EBRx Call Center uses a unique approach to managing PAs by using our pharmacy staff to facilitate this process. When a request for a non-preferred medication arises, the prescriber will phone the EBRx Call Center to have a clinical encounter with a drug expert to determine if there is a legitimate need for the non-preferred medication.
Additionally, the EBRx Call Center pharmacy staff is ideally situated to facilitate outbound communications to prescribers to alert them of changes to the PDL and potentially inappropriate patterns of medication usage (see DUR Functions).
Program Evaluation
EBRx offers access to the UAMS College of Pharmacy’s Pharmaceutical Evaluation & Policy (PEP) Division. Pharmacy benefits are typically purchased as carve outs and as such, pharmacy costs are often considered as an independent cost item. At EBRx, we recognize that if not thoughtfully implemented, a program to control one set of costs may result in increases in other areas of your healthcare expenditures. The researchers in PEP are skilled in evaluating the impact of prescription benefit decisions on total healthcare costs.
PBM Contract Consulting
The UAMS College of Pharmacy and EBRx offer access to consulting services to advise clients during their contracting period with PBMs. These services can assist a payor in knowing the right questions to ask when considering partnering with a PBM, as well as knowing what contractual elements should be in place to ensure that you get the most from your pharmacy benefit.
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