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Drug Utilization Review

The worker's compensation market is associated with disproportionately high pharmacy costs. In many cases, drug expenditures are unnecessarily inflated. Novare can help avoid or minimize financial risk from pharmaceutical costs.

Novare's Pharmacy Case Management Program can provide significant savings. Evidence-based Drug Utilization Reviews exceed industry standards because our clinical pharmacy staff has the unique ability to blend clinical and economic considerations. The results speak for themselves.

Drug Utilization Review and Medicare Set Asides

When conducting a projection of future pharmacy costs, several factors should be considered such as drug patent life and cost of drugs in the marketplace. Leveraging Novare's unique experience and knowledge of the pharmacy marketplace can translate into significant financial savings. Drug Utilization Review can save 20% to 40% or more on pharmacy cost projections.

The truth is in the numbers. Below are the cost savings achieved on the following real-world cases:

Example

Lifetime Pharmacy Cost Before the DUR

Lifetime Pharmacy Cost After DUR

Savings

Case #1

 $152,193.22

 $1,945.52

 $150,247.70

Case #2

 $84,689.54

 $30,333.30

 $54,356.24

Case #3

 $550,035.29

 $252,670.58

 $297,364.71

Case #4

 $229,416.49

 $192,583.69

 $36,832.80

Case #5

 $48,361.00

 $28,467.00

 $19,894.00

Case #6

 $50,536.00

 $16,644.00

 $33,892.00

Case #7

 $128,429.54

 $43,454.00

 $84,975.54

Case #8

 $120,416.62

 $90,915.12

 $29,501.50

Case #9

 $91,443.90

          $67,561.56

$23,882.34

Case #10

 $65,829.36

 $37,323.36

 $28,506.00

Case #11

$20,739.0

           $6,977.35

$13,761.65

Case #12

$150,437.26

          $99,746.66

 $50,690.60

Case #13

$1,118,596.20

     $1,020,595.68

 $98,000.52

 

 

 Total Savings

     $1,123,339.24

Drug Utilization Review and Clinical Services

Clinical services are delivered in the context of pharmacy case management and medical peer review. These reviews integrate patient care considerations with a variety of other considerations, including but not limited to:
  • Relative drug effectiveness
  • Relative drug safety
  • Brand vs. generic drug therapy
  • Acute vs. chronic drug therapy
  • Duration of drug patent life
  • Non-injury related drug use
  • Off-label (unapproved) drug use
  • Physician dispensing
  • Compounded prescriptions
  • Predatory prescription pricing
The above clinical services are integrated into economic data to provide compelling, value-driven, evidence-based information that assists adjusters and case managers in working with prescribers, benefiting both the patient and payer.

Sample DUR

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