Utilization Management

The Peoples Health Pharmacy department, in conjunction with the contracted pharmacy benefits manager, maintains management reports and systems to assist in preventing over-utilization and under-utilization of prescribed medications including but not limited to, the following:

  • Compliance monitoring to improve adherence/persistency with appropriate medication regimens
  • Monitoring procedures to discourage over-utilization through multiple prescribers or multiple pharmacies
  • Quantity versus time edits
  • Early refill edits

The Pharmacy department maintains methods to ensure cost-effective drug utilization management. These may include but are not limited to the following:

  • Step therapy
  • Prior authorization
  • Tiered cost-sharing
  • Quantity limits