Clinical Optimization

Clinical optimization services include:

• Program review and recommendations on major market events, ensuring minimal member disruption and consistent clinical outcomes
• Review of the current and proposed utilization management and formulary programs, with specific recommendations for optimal management of the pharmacy program 
• Support for your plan design strategy development for the upcoming plan year, including benchmarking of design elements and financial impact modeling  
• Review of claims and utilization data and identification of cost-reduction opportunities, such as therapeutic class evaluation, disease intervention strategies, and generic substitution

Powered by Artemetrx, we utilize claims-level detail to quantify the current impact of pharmaceuticals and to forecast potential growth in utilization and drug spending. Our forecasting models include key assumptions regarding overall utilization, channel utilization, generic dispense rates, growth in key therapeutic classes, specialty drug utilization, anticipated impacts of new drug launches (including generics), and many other factors. These assumptions are driven by monitoring industry trends, data mined from PSG’s data warehouse, and client-specific data/trend analysis.