UTILIZATION MANAGEMENT AND PRESCRIPTION BENEFITS

HealthSmart's Utilization Management program is designed for employers and providers to ensure optimal, cost effective outcomes while maintaining a focus on quality care for members. Continuous monitoring of prescription use and communication with healthcare providers allows us to follow the patient throughout the healthcare delivery system and assure that appropriate resources are utilized. Reports are generated on a regular basis to provide meaningful interpretation of data regarding analysis of utilization, savings, and the impact of benefit design. The most successful Utilization Management programs for use with prescription benefit plan are Prior Authorizations, Step Therapy, Specialty Medication Services, Dosage Optimization and Over-the-Counter Strategies.


Prior Authorizations

With prior authorization services, certain prescription medications — such as those known to have safety issues, those most commonly mis-used or those with excessively high costs —are reviewed by our Utilization Management team. Typically, these types of medications require the physician to request a review and approval before the member receives the medication.

Prior Authorization is a source of frustration for members. At HealthSmart Rx Solutions, our Utilization Management team carefully selects the problematic medications based on certain criteria and implements processes to reduce delays for patients.