Certilytics Helps Employers, Health Plans Gain a Complete Picture of Pharmacy Utilization
By Deanna Stearns
Senior Pharmacy Analyst, Certilytics
Specialty drugs are one of the largest drivers of rising healthcare costs—and a growing challenge for employee benefit managers and health plans focused on total cost of care.
Over the past few years, Certilytics has helped many of the nation’s largest health plans and self-funded employers implement successful, cross-benefit, pharmacy cost management strategies. While every strategy is different, based upon unique diagnostic and utilization patterns, each customer has been able to make more impactful decisions with insights from integrated pharmacy reporting tools.
A comprehensive view of pharmacy utilization is crucial because, more than ever, specialty drugs are administered in a medical setting and billed through the medical benefit rather than the pharmacy benefit. Indeed, the emergence of a growing number of infusion therapies, cancer treatments, biosimilars, and gene therapies only serves to complicate the picture and make it harder for decision makers to understand which specific drugs (or providers) are most responsible for inflating overall drug costs.
Our pre-built and custom reports and visualizations—part of the Nucleus Analytics Platform—empower analysts and benefit managers with the information they need to quickly discover what’s driving these trends and unlock opportunities for effective and impactful cost-management strategies.
As a Senior Analyst with more than 15 years of experience working with payers and pharmacies, here are some of the questions I’ve helped our customers answer using the Nucleus Analytics Platform:
- Are we succeeding in our efforts to steer members to a preferred drug?
- Which drugs are newly utilized?
- Which drugs are being prescribed for which conditions?
- Which conditions are the top drivers of integrated pharmacy spend?
- What are the key components of trend by site and condition?
- Is there a controllable condition that is seeing an increase in non-pharmacy utilization?
- What channel/site are my oncology drugs going through?
- Are specialists providing the specialty drugs? Which providers?
- Is change in drug mix or price driving retail pharmacy costs?
- Which generic drugs have the largest increase in average costs?
- Which therapeutic classes are driving trend?
- Are high cost drugs driving trends? Which drugs? Which conditions?
- Are new or existing patients driving diabetic trends?
- What is my biosimilar substitution rate by condition and provider?
Contact us for a free consultation on how we can help supercharge your integrated pharmacy reporting to manage your total healthcare costs.
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