Your pharmacy benefits manager may produce beautiful reports and retain troops of competent staff, but it probably is not watching your group’s narcotic painkillers. Most PBMs do not utilize warning systems to flag high use or potential abuse of narcotics. Armed with a calculator and standard PBM reports, though, you can spot major problems and get something done about them.
Your first step is to find the PBM report that addresses “indication” — the illness or condition that the drug is treating. Then, indentify the indication of pain. The report likely will note “Rxs,” which is the number of prescriptions filled, and may also have “patients.” Calculate the number of patients receiving pain medications as a percentage of your whole covered group.
