Managing Utilization to Control Costs
Diabetes often ranks as the top trend driver, accounting for a quarter of pharmacy spend. The recent surge in GLP-1 prescriptions—many prescribed for off-label use—has only added to the financial burden. Loose reins on this trend driver will be costly for plan sponsors.
A client with 30,000 lives faced a significant challenge with rising pharmacy costs. Their growing use of GLP-1 medications added further pressure, so they partnered with WellDyne to control their pharmacy spend.
Enhanced Guideline Management
As part of their implementation, all GLP-1 prescriptions underwent a thorough coverage review to ensure appropriate and effective usage. By diligently managing utilization, WellDyne delivered significant cost savings through:
- Reducing off-label usage: Strict adherence to evidence-based clinical guidelines prevented 36% of prescriptions for off-label use, ensuring GLP-1 medications were prescribed to treat type 2 diabetes.
- Shifting to first-line therapy: Prescriber engagement closed gaps in care and optimized 12% of prescriptions by guiding members toward lower-cost alternatives before advancing to GLP-1 therapies.
Undisputed Results
Despite the denial of over 50% of requests for access to GLP-1s, only 10% were appealed by the prescriber—reinforcing that most knew they were prescribing the medications more aggressively than necessary. Less than half of the appeals were overturned, reducing the denial rate by only 3 points. WellDyne delivered a targeted approach to managing GLP-1 utilization, allowing the client to maintain high-quality care for members while significantly lowering costs.
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