Over the past several months, the Trump administration has introduced several ideas intended to fight skyrocketing prescription drug prices – everything from forcing manufacturers to display prices in their television commercials to having Medicare base payments for costly drugs on average prices in other industrialized nations, which are much lower than in the U.S.
While some prefer to criticize or sit silently by as prices keep rising, we say keep the ideas coming. This is a crisis requiring aggressive action, like our Pharmasense program, that tackles the real problems driving the cost of specialty drugs used to treat complex medical conditions.
Prior Authorization (Pre-Certification) is at the core of Pharmasense. It helps self-funded health plans avoid potential conflicts of interest that enable massive mark-ups and other abuses go unchecked. Pre-certifying specialty drug prescriptions prevents hospitals or PBMs from reviewing authorizations and dispensing specialty drugs without any independent review process. The same is true when providers submit specialty drug prescriptions as claims under the medical plan rather than the prescription drug benefit plan. As an independent TPA, we use these tools to deliver quality patient outcomes and significant cost savings by avoiding the kinds of conflicts described above.
If your prescription drug costs are spiraling out of control, it’s time to take serious action. Talk to us about ways to prevent Pharmacide today!