Rx Utilization Factors

You are currently viewing Rx Utilization Factors

Ensure Data Solutions always said that utilization has become a key factor when we talk about reducing cost of healthcare and prescription drug expenses is big part of it.

Overutilization leads directly to higher health care costs. There are many reasons overutilization occurs, including the way in which the U.S. health care pharmaceutical delivery system works. For example, in the fee-for-service system, many physicians are ultimately paid based on the number of services they provide, and pharmacies are reimbursed based on the number and daily supply of prescriptions they fill. 

Overutilization can also be driven by direct drug marketing that creates demand from patients who observe a drug advertisement for a condition they may have and request their physicians prescribe drugs without adequate information on alternatives, contraindications, side effects, or efficacy, driving the US healthcare cost to rise.

I recommend an important link on: Health improves efficiency

receta medica

Lack of patient compliance can, also, be an issue. These occurs when patients do not follow appropriate drug treatment protocol, especially maintenance medications, such as those that treat diabetes and hypertension. Recent studies have shown that approximately one in seven adults in the United States did not fill a prescription, the number increases for individuals with two or more chronic conditions. Such practice can lead to much higher medical costs later for an individual patient, if the patient incurs in a stroke, heart attack, or some other occurrence as a direct result of failing to take the appropriate level of medicine. Leading to a much higher expense and, indeed, raise the health care costs in retirement.

Another issue that raise the healthcare costs is that physicians prescribing brands over generic. Brand prescription drug costs has a much higher cost per unit. Brand drugs typically experience even higher price increases as their exclusivity period ends. New brand drugs are often introduced at prices higher than the current drugs they are aiming to replace. Historically, switching to a generic form of a drug tend to result in lower prices and control long term health care costs.

Utilization of drugs is a result of many factors including categories of patients for particular drugs, changes in disease prevalence, revisions in treatment regimen, and more effective disease identification, often as a result of improved access to preventive screening. To manage such utilization a software can be of great help, check tools like www.ensuredatasolutions.com

Learn how to save money and still receive the care you need.

Start by looking at your plan information so you know what services are available.

Try the tips below to help you get the most from your benefits and save money on your care.

Save money on your care.

1. Save Money on Medicines

  • Ask your health care provider if you can switch to generic medicines. They have the same active ingredient, but cost less than brand name drugs.

  • Ask your provider if there is a less expensive medicine that treats the same condition.

  • See if you can order your medicine through the mail.

  • Take all of your medicines as directed. Not taking your medicine or not taking enough medicine may lead to further health problems.

2. Use Your Benefits

  • Get routine health screenings. These tests can catch health problems early, when they may be more easily treated. And you often do not have to pay a copay for health screenings, vaccines, and annual well visits.

  • Get prenatal care if you are pregnant. This is the best way to ensure you and your baby will be healthy.

  • Some health plans offer health advocates or case managers. A health advocate can help you get the most of your benefits. A case manager can help you to manage complex health problems such as diabetes or asthma.

  • Use free and discounted services. Many health plans offer discounts on things like gym memberships or eyewear.

3. Plan Ahead for Urgent and Emergency Care

When an illness or injury occurs, you need to decide how serious it is and how soon to get medical care. This will help you choose whether to call your provider, go to an urgent care clinic, or get emergency care.

You can decide where to get care by thinking about how quickly you need care.

  • If a person or unborn baby could die or have permanent harm, it is an emergency. Examples include chest pain, trouble breathing, or severe pain or bleeding.

  • If you need care that cannot wait until the next day to see your provider, you need urgent care. Examples of urgent care include strep throat, bladder infection, or a dog bite.

You will save both time and money if you use an urgent care center or see your provider rather than going to the emergency department. Plan ahead by knowing which urgent care center is near you. Also, learn how to recognize an emergency in adults and in a child.

4. Ask About Outpatient Facilities

If you need a procedure or surgery, ask your provider if you can have it done at an outpatient clinic. Often, getting care at a clinic is cheaper than having the same procedure in a hospital.

5. Choose In-Network Health Care Providers

Depending on your health coverage, you may have the choice to see providers who are in-network or out-of-network. You pay less to see providers who are in-network, because they have a contract with your health plan. This means they charge lower rates.

6. Take Care of Your Health

A simple way to save money on health care is to stay healthy. Of course, that is sometimes easier said than done. But staying at a healthy weight, getting regular exercise, and not smoking lowers your risk for health problems. Staying healthy helps you avoid costly tests and treatments for ongoing conditions such as diabetes or heart disease.

Ensure Data Solutions Mobile App

When we talk about reducing cost of healthcare and prescription drug expenses is a big part of it.

 

References

American Board of Internal Medicine (AMBI) Foundation. Choosing wisely: patient resources. www.choosingwisely.org/patient-resources. Accessed October 29, 2020.

Centers for Disease Control and Prevention website. See which screening tests and vaccines you or a loved one need to stay healthy. www.cdc.gov/prevention/index.html. Updated October 29, 2020. Accessed October 29, 2020.

Healthcare.gov website. US Centers for Medicare & Medicaid Services. Preventive health services. www.healthcare.gov/coverage/preventive-care-benefits. Accessed October 29, 2020.

US Preventive Services Task force. Browse information for consumers. www.uspreventiveservicestaskforce.org/uspstf/browse-information-consumers. Accessed October 29, 2020.

Leave a Reply