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How Data Analytics Can Improve Your Performance of Drug Utilization Review Programs

Updated: Apr 24




Everyone in the pharmacy benefits industry has a stake in improving health outcomes for patients while lowering costs. One of the key stumbling blocks in balancing the outcome-cost equation is having the ability to rapidly respond to negative drug utilization behaviors. Yet, most pharmacy benefits managers won’t find out about problematic utilization trends until 3 or 12 months after the fact. By then, it’s too late to intervene.


The first step to improved drug utilization review is establishing real-time data connectivity, giving benefit management companies a tool to quickly review and intervene with appropriate strategies. The result? Healthier patients, happier clients, and increased savings for everyone involved.


Here are some of the issues in drug utilization that data analytics can help to answer.


Flagging High-Cost Drugs

High-cost specialty drugs are often life-saving for patients with rare diseases, but can be staggeringly expensive. One notable outlier example is the drug regimen Zolgensma, which has cured spinal muscular dystrophy in many children, yet has a list price of $2.1 million for a course of treatment.


More common diseases, such as multiple sclerosis, Hepatitis C or cancer are also increasingly treated with high-cost specialty drugs. And new, costly remedies are always in the pipeline of development. Sometimes, there’s no alternative to higher-cost drug treatment, but when there’s an appropriate substitute, data analytics can help to identify it quickly.


How Xevant’s Real-Time Data Makes a Difference

Xevant’s ClinicalLogic module alerts managers in real-time when a high-cost drug enters the system and identifies generic alternatives or presents insights to develop appropriate drug utilization review programs. This immediate access to actionable information enables managers to:

  • Inform patients in advance on how the drug fits into their plan’s co-pay structure

  • Examine the patient history to determine the appropriateness of the prescription

  • Educate patients and caregivers on proper administration and storage

  • Negotiate discounts with the drug manufacturer

  • Suggest possible DNA testing, to determine if the proposed medicine will be effective


Identifying Non-adherent Patients

The reality is, the cost of drugs doesn’t matter if the patient doesn’t take it. Non-adherence not only hurts the patient, but also contributes to skyrocketing healthcare costs that come from avoidable health complications and hospitalizations. In 2015, Forbes reported that non-adherence costs an estimated $290 billion, which accounted for about 13% of total spending on healthcare nationwide.


There are many reasons patients decide not to fill their prescriptions or stop taking them. Data analytics can help combat some of the factors that may contribute, such as high co-pays and uncomfortable side effects, by identifying other, more suitable options.


How Xevant’s Real-Time Data Makes a Difference

With its daily reports and alerts, Xevant’s X3 platform enables pharmacy benefit managers, payers, and consultants to know when a patient has been identified as non-adherent. As a result, this helps all stakeholders plan interventions or programs to help fight non-adherence. For instance, managers might seek a suitable therapeutic option that fits into a program’s Tier One co-pay to reduce patients’ out-of-pocket expenses.


They could also develop digital or telephone alerts and educational programs to better inform patients about the negative health consequences of non-adherence to medication as prescribed.


Predicting Outcomes and Managing Disruptions

The COVID-19 pandemic provides more than a few cautionary tales of how disruptions can cause mayhem in medicine. Media reporting around hydroxychloroquine as a possible remedy for the disease caused a sudden surge in demand in March, sparking concerns about shortages for other populations who rely on the drug to manage lupus and other autoimmune diseases.


In situations like these, where there is an unpredictable demand for medication, a delayed reaction could lead to irrevocable consequences for the patient. Data analytics allows healthcare managers to identify trends quicker so that they can predict possible disruptions and work to manage them before it happens.


How Xevant’s Real-Time Data Makes a Difference

Tracking positive (or negative) outcomes from the proper use or misuse of medication is another area where Xevant’s analytics can help. Because Xevant provides near real-time analytics, it makes it easy for customers to predict the response of specific medications and/or work to manage any disruption it has - whether that affects patients or providers.


For example, if an influx of generic drugs hits the market and starts increasing prices, Xevant will alert you to make necessary changes. Data analytics from Xevant gives benefits managers the information they need to plan, respond, and develop appropriate drug utilization programs.

Xevant, The Game-Changer

The typical pharmacy benefits manager, payer, or consultant is fed millions of data points every day making the process of identifying useful information feel overwhelming. Xevant offers a solution.


Xevant’s robust and flexible platform serves as your 24/7 digital assistant, bringing the best of “Big Data” to bear on medical cost and health outcomes through these features:

  • Access to enhanced claims data, refreshed daily and integrated into many other data resources resulting in real-time access to actionable insights.

  • Customized platform that can be set to automate patient or clinician alerts to aid them in making timely decisions.

  • Performance tracking insights are presented every morning, compiling previous day’s activities based on KPI’s set by managers.

With so much at stake in dollars and lives, Xevant is seen as an industry game-changer. With Xevant, easily improve the performance of existing clients and easily win new ones.


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