Flagging Hidden Anomalies in Your Pharmacy Benefits Data

A 400% utilization spike for a single drug outlier was identified through Artemetrx, allowing the plan to promptly prevent further leakage.

The Challenge

Miebo is a brand medication approved in 2023 for the treatment of Dry Eye Disease with an average cost of around $800 per month. Used appropriately, it can be a helpful therapy, but the challenge for one health plan was a systematic issue often missed by traditional PBM monitoring. Fortunately, this plan had invested in Artemetrx, a comprehensive integrated data and analytics tool, and this outlier was quickly identified and resolved.

With Artemetrx, a clinical consultant quickly identified a utilization spike for Miebo of 400% in claims per member and 250% in users across the plan. With a quick drill-down to claim- and member-level details, the consultant identified members with abnormally high fills for the medication. Artemetrx’s capabilities, such as quick click-throughs to pharmacy and prescriber details associated with these suspicious claims, further validated that this was a potential fraud, waste, and abuse (FWA) issue. What’s more, this overutilization presented a patient safety risk.

PSG’s Supporting Services

Artemetrx: An integrated platform that transforms data into intelligence, driving improved management of drug spend and trend across both the pharmacy and medical benefits.

Clinical Consulting: Our team of experienced pharmacists provides unbiased clinical expertise to help clients make informed decisions that optimize their plans.

Learn More

PSG’s analytics tool, Artemetrx, leverages integrated data to give you a complete view of your data so you don’t miss anything that could hurt you down the line. Learn more by downloading the full case study!