Utilization Management

Prescription Drugs

The Peoples Health pharmacy department,  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/persistence 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