ADHD medication utilization management program improves care and savings

Student-focused core principles guide our pharmacy program and proprietary student formulary. Chief among them are managing prescription utilization and improving our formulary based on market trends, conditions and symptoms faced by students. We’re constantly reviewing our offerings and ways to improve access to clinically appropriate treatments while reducing costs for our client schools and student members. Part of that effort includes utilization management strategies.

What are utilization management strategies?

Utilization management strategies are procedures put in place to help ensure student members are receiving the most appropriate medications, while lowering the overall cost of health care. For Wellfleet, all of the techniques included are based on FDA labeling data to ensure clinical appropriateness and safety. The utilization management strategies used include step therapy, quantity limits, and prior authorizations.

  • Step therapy – A practice that starts members with preferred medications for their treatment, before non-preferred medications are covered. Preferred medications are clinically safe, and they help lower member and plan costs
  • Quantity limits – A structure that puts a limit on the quantity dispensed, to help ensure safe and appropriate dosing.
  • Prior authorizations – A pre-approval process where criteria needs to be met prior to obtaining the medication and can include documentation provided by the prescriber. This helps promote safe and effective medication use.

Utilization management strategies for ADHD medications

To understand the impacts of the procedures, the financial outcomes associated with pharmacy utilization management strategies applied to attention-deficit/hyperactivity disorder (ADHD) medications over one semester, from July through December of 2020, were analyzed.

This is important because it’s been estimated that between two and eight percent of college students in the United States (U.S.) have ADHD. And for those students with ADHD, college life can be a struggle. This can be attributed to the ability to maintain focus with their school and social life balance, which contributes to difficulty in excelling in either school or social environments and may result in students having low self-confidence, feeling behind compared to fellow students, and poor grades.

Further, for Wellfleet, the ADHD drug class is the fourth largest category of medications, with Vyvanse® accounting for 64 percent of total spend in this class.

Cost savings from ADHD utilization management

Over the five-month period, from July through December, more than 400 ADHD medications were flagged for utilization management. Of these medications that were flagged, about half (49%) were ultimately denied and alternative clinically appropriate and safe options were determined by the prescriber.

When analyzing plan savings for participating schools across this one semester in 2020, the data revealed that these techniques are working. In addition to helping provide student members with the best results from their treatment, these programs help save money for both the student member and the schools.

Overall, Wellfleet school partners saved almost $200,000!

Learn more about the benefits and cost savings that can be realized with health and pharmacy solution from Wellfleet Student.

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