Utilization Management Efforts Have Their Own Costs

August 2021

Drug utilization management has long been a tool used by health plans, pharmacy benefit managers, and states to effectively manage their pharmacy costs. Those management efforts have costs of their own and a recently published review seeks to quantify those burdens to patients, providers, manufacturers, and payers. The review reports that these stakeholders have combined costs of $93.3 billion annually in managing these efforts and with the advent of increasingly innovative medicines, that number is expected to increase.

For a system that is shifting to value, these costs and their impacts on patient health and outcomes should not be lost either. Providers are reluctant to take on risk when patients may not be able to access the therapy that may provide the preferred clinical and patient-centered outcome.

Discern hopes calling attention to these costs can foster a holistic look at these utilization management efforts and their intended and unintended impacts on value-driven care.

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