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New medications approved by the FDA can lead to financial impacts for your benefits spend. Accessing your medical and Rx claims data can help – if you know ahead of time what new drugs are hitting the market, you can work with your PBM to put in place prior authorization criteria and ensure new drugs are only being used for patients who need that specific new therapy.
This may include criteria that restrict medications to patients of certain age groups, disease severity levels, or other medications tried and failed.
You can also stay on top of potential enrollees who may need a new drug therapy to forecast budgets and conduct preemptive reviews. Some of the medications in the list below could cost anywhere from $200 to $90,000 per year per patient - or more.
In the first quarter of 2017, twelve medications were approved by the FDA:
If you are a current Artemis client, you can access the number of patients with diagnosis codes that correspond to one of the above indications. This will help you pinpoint which medications you may want to discuss with your PBM. Click here to look at your population.
Please note: These are NOT current members taking these drugs (some haven't hit the market yet) - it's just a way of seeing how many of your members may need these drugs in the future based on diagnosis codes.