Payers Struggle to Square Utilization Management Scrutiny, Rising Drug Costs
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Jan 23, 2025
Payers expect to face higher medication costs in the coming years with the increased adoption of GLP-1 agonists, cell and gene therapies, and other expensive drugs, according to Mary Beth Erwin, chief pharmacy officer at Blue Cross Blue Shield of Massachusetts. However, Erwin acknowledged during a recent webinar sponsored by the National Institute for Health Care Management (NIHCM) that traditional tools to manage costs are “increasingly the target of scrutiny and reform at all levels.”
Erwin, who is responsible for BCBS of Massachusetts’ medication management strategies, mentioned that the insurer has implemented several ways to rein in costs, including formulary and utilization management “to ensure cost-effective and clinically appropriate access to medications while also maintaining quality of care.”
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