Catastrophic Care Part 2- Carrier PerspectiveAugust 9, 2023
In the first quarter of 2023, VI saw that 45% of utilizers were being provided the drugs approved only for Type 2 Diabetics without having a medical diagnosis of diabetes. During the past few months, we have seen a sharp improvement from many PBM’s in improved prior authorization processes. Some PBM’s have issued refunds to employers for the dollars spent on persons who should not have been able to fill their prescriptions.
The best approach is to have data to provide prove your concern of off label utilization in order to hold your PBM accountable. We have found the best approach is to increase your prior auth process to include documentation review, not just a diagnosis written on the script and consider adding failure to control A1c levels on a more cost efficient medication. There is a lot of concern related to the side effects of these medications, including the American Society of Anesthesiologists warning that due to the slow down of food digestion, persons are at higher risk of asphyxiation during surgery. A good article to share with employers is Inc. – where our managing partner, Mary Delaney is a contributor.