Report Quantifies Cost of Utilization Management Wars

Prescription drug utilization management and moves to counteract it introduce billions in costs to payers, providers, manufacturers and consumers alike, a new report suggests. The report, published in the journal Health Affairs by researchers from the University of California, Berkeley and Novartis Pharmaceuticals Corp., argues that such practices inflate already-too-high drug prices — though one outside expert says she is skeptical about some aspects of the study.

The research article concludes that utilization management practices could introduce as much as $93.3 billion to the U.S. health care system annually. Some of the cost drivers identified in the article include, for payers, “cost of administering prior authorizations”; for manufacturers, the cost of “administrative support programs,” “direct financial payments to assist commercially insured patients” and providing insured patients with free medications; for physicians, the “cost of physician practices’ time interacting with payers over prior authorization”; and for patients, “spending on branded drug cost sharing.”

© 2023 MMIT
Peter Johnson

Peter Johnson

Peter has been a reporter for nearly a decade. Before joining AIS Health, Peter covered a wide variety of topics in his hometown of Seattle, where he continues to live. Peter’s work has appeared in publications including The Atlantic and The Stranger. Peter attended Colby College.

Related Posts

doctor-speaking-to-a-patient
May 25

Commercial Insurance Restrictions Complicate Biosimilar Adoption

READ MORE
shell-game
May 25

‘Shell Game’ or Rebate Maximizers? FTC Probe Reignites Debate Over GPOs

Read More
pills-in-hand
May 25

As Weight Loss Drugs’ Star Rises, Plan Sponsors, Researchers Worry About Costs

READ MORE

GAIN THERAPEUTIC AREA-SPECIFIC INTEL TO DRIVE ACCESS FOR YOUR BRAND

Sign up for publications to get unmatched business intelligence delivered to your inbox.

subscribe today