Pharmacy utilization management (UM) is no longer a targeted intervention applied to exceptional therapies but rather is increasingly utilized for most branded medications, first through formulary exclusion, followed by prior authorization. In a health economy where pharmacy spending is disproportionately driven by high-cost therapies with list prices frequently exceeding $1,000 per month, payers and employers have legitimate reasons to manage utilization. Even so, the increasing use of formulary exclusion for biosimilars calls into question whether UM is a tactic to steer volume toward a PBM-affiliated private-label product or to preserve rebate arrangements rather than to control utilization of an inherently high-cost therapy.
Read the full article: Pharmacy Utilization Management Expands as Nearly Half of Initially Rejected Prescriptions Go Unfilled //
Source: https://www.trillianthealth.com/market-research/studies/pharmacy-utilization-management-rejected-prescriptions-unfilled