Uncover Hidden, Duplicate Drug Expenses

Quickly Identify Inappropriate Concurrent Use with Artemetrx Data and Analytics

Key Points:

• Inappropriate concurrent medication use can drive unnecessary cost and increase safety risks, especially when members use duplicate therapies or switch medications frequently.
• Some drug combinations offer no clinical benefit, yet are commonly used together and can be very costly to plans.
• Dynamic reporting can help payers quickly identify true duplicate therapy issues, distinguish ongoing patterns from one-time occurrences, and focus interventions on the right members and prescribers.
• Artemetrx Concurrent Use reporting reveals top categories of costly or risky overlap, including GLP-1s, CGMs, CGRPs, opioids with benzodiazepines, and certain HIV drugs.

Medications are commonly used in combination to treat chronic conditions like diabetes and high blood pressure, which can be highly effective. Yet at times, combinations of medications are unnecessary and can add to healthcare costs, even putting individuals at increased risk of side effects. For healthcare payers who want to manage and avoid inappropriate concurrent use, it can be challenging to easily identify the right opportunities.

Clinical managers need a systematic way to:

• Focus on members and therapies for which concurrent use of medications is suboptimal
• Identify members who have continued use, which may be a target for intervention, versus those who are simply changing therapies
• Distinguish between isolated occurrences and ongoing trends that persist month after month
• Access reporting that is timely and reflects recent utilization

Use Case: Duplicate GLP-1 Therapies

With high cost GLP-1s driving pharmacy trend for many, avoiding unnecessary spending related to concurrent use is critical. Yet our consultants repeatedly observe concurrent use of GLP-1s driving unnecessary costs. Adding to the complexity of managing and reducing inappropriate concurrent use is the frequent switching of GLP-1s by patients due to shortages or affordability, as well as a lack of care continuity as patients seek access to the medications through providers and pharmacies outside of their primary care.

However, with the right reporting that focuses on the most targeted members and prescribers for intervention, the results can be more than worthwhile. With our clients, we have observed an estimated $5,000+ annualized savings per member for plans when the combination use is addressed.

Solving For Concurrent Use Challenges with Artemetrx

PSG’s proprietary integrated data and analytics platform, Artemetrx, delivers actionable concurrent use reporting with our clinical and pharmacy benefit experts continuously monitoring opportunities for edits. By using more comprehensive reporting rules grounded in sound clinical guidance, users can identify true concurrent use red flags much earlier than in traditional, less comprehensive reporting views. We also support payers in implementing best practice strategies based on these findings. This support includes guidance on establishing edits within the pharmacy claims processing system to prevent concurrent use and crafting impactful communications for providers.

• PBM edits for non-overlapping use: While PBMs can implement edits to prevent overlap, these edits don’t always catch every instance.
• Data-driven results: These insights help identify gaps or confirm that management strategies are working as intended.
• Variation across PBMs: The effectiveness of edits differs by PBM and operational approach, reinforcing the need for a neutral and expert third-party.
• Added value of Artemetrx reports: Our reports verify how PBM edits are functioning in practice. For example, edits may fail across delivery channels, such as when a member receives medication from both mail order and retail pharmacies, or when member-specific overrides affect how concurrent medication edits are applied.

Top Concurrent Use Categories in Artemetrx

• GLP-1s: Determine when patients are at risk of increased side effects while also reducing unnecessary spend on duplicate treatments.
• CGMs (Continuous Glucose Monitoring): Highlight members who may be confused about how to use their CGM correctly.
• CGRPs (Calcitonin Gene-Related Peptide inhibitors): Identify members on multiple preventives or multiple acute CGRPs with limited clinical benefit, showing opportunities for use of other migraine therapies.
• Opioids and Benzodiazepines: Gain insight into members at higher risk of safety concerns such as falls, accidents, and increased abuse potential.
• HIV Drugs: Show duplicate active ingredients leading to higher than recommended doses with safety and unnecessary cost concerns.

See how Artemetrx identifies costly and dangerous drug overlaps, turning insights into savings and better patient outcomes. Schedule a demo today to explore the Concurrent Use report in action by reaching out to our experts at [email protected]!

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