How to Shield the Pharmacy Benefits Plan From Unnecessary Risk

Top 3 Things You’ll Learn

  • How prescribing leads to inappropriate prescription utilization and added costs
  • What makes a pharmacy benefits utilization management strategy effective
  • What questions to ask to gain insight into employer pharmacy benefits data

Not too long ago, 27% of doctors admitted to writing a prescription for a medication with questionable value to the patient.1 Not only that, but when patients receive a medication for an off-label use, reports indicate that there’s a 54% likelihood the medication will cause an adverse drug event.2 Imagine how many more times this happens but is not reported, and the impact these practices can have on your self-funded employer clients and their members.

27% of doctors have prescribed a drug with questionable value. Is your pharmacy benefits plan shielded from this potential risk? #drugcosts

As more high-cost medications come to market, your self-funded clients need a clinical shield to protect them from inappropriate utilization and unnecessary costs. A tailored utilization management strategy for their prescription drug program can help you put the necessary protections in place to guard your clients against potential pharmacy risks – risks that could cause irreparable damage if not properly monitored.

An effective pharmacy benefit clinical strategy has two goals: enhancing member safety and providing economic value to employers. Designing the optimal strategy requires using data analytics to evaluate how your clients’ health benefits budgets are being impacted by high-cost prescription drugs. Use these questions to help gain detailed insight into their current prescription drug utilization patterns so that you can determine the optimal strategy to help them overcome their specific risk areas:

  • Which drugs are being utilized the most by members?
  • What are the most expensive drugs being utilized?
  • Are the employer’s pharmacy dollars being spent on the most appropriate drugs?

As your clients move into the future, likely with uncertainty of what it may hold for their businesses and their valued employees and plan members, it’s vitally important to be able to answer these questions. Only then can you get started with helping them make informed decisions on how to address their specific risk areas using targeted pharmacy solutions that have their best interests – their bottom line and members’ wellbeing – in mind.

To learn more about applying data-driven clinical management strategies to your clients’ pharmacy benefit plans, check out our free Clinical Strategies Playbook.



1) Thompson, D. U.S. Doctors Still Over-Prescribing Drugs: Survey. Annals of Internal Medicine, Dec. 5, 2016.
2) Tamma PD, Avdic E, Li DX, Dzintars K, Cosgrove SE. Association of Adverse Events With Antibiotic Use in Hospitalized Patients. JAMA Intern Med. 2017;177(9):1308–1315.

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