Price Opportunist List and Smart PA Program Drive Decrease in Topical Utilization and Spend

Problem

A workers' compensation carrier noticed a significant increase in their spending on dermatological/topical therapeutic class (TC) medications, despite stable patient numbers. Although the volume remained steady, the costs were disproportionately high, placing these medications among their top five in terms of expenses, reaching the fourth position.

Solution

Enlyte identified low volume and high-cost price outliers to develop an NDC level exclusion Price Opportunist Drug List. Collaborating closely with the customer, they paired this list with the Smart PA Auto Adjudication functionality to create a program to auto deny select price opportunist meds, such as private label topical analgesics (PLTAs) and select prescription topicals.

Outcome

The Enlyte Price Opportunist List and Smart PA program solution has been a huge success from a drug mix management and cost containment standpoint. As a result, over a four-year period, the derm/top TC script count has dropped from a peak of 652 to 244, spend has decreased from its peak of $232k to $50k, and derm/tops are no longer a Top 10 TC by spend.