Cost Driver Analysis Framework
- 1Top drugs by total cost: Identify the top 20 drugs by total plan cost
- 2Top drugs by cost per member: Identify drugs with the highest cost per member
- 3Top therapeutic categories: Identify the therapeutic categories driving the most cost
- 4Top prescribers: Identify prescribers with unusually high-cost prescribing patterns
- 5Cost trend analysis: Compare current period costs to prior period to identify emerging trends
- 6Benchmark comparison: Compare your costs to industry benchmarks
Specialty Drug Cost Analysis
Specialty drugs typically represent 50–60% of pharmacy costs despite only 1–2% of prescriptions. A specialty drug cost analysis identifies: (1) the top specialty drugs by cost; (2) the number of members using each specialty drug; (3) the average cost per member per year; and (4) the trend in specialty drug costs. This analysis informs specialty drug management priorities.
Prescriber Pattern Analysis
IQ Insight
Prescriber pattern analysis identifies prescribers with unusually high-cost prescribing patterns. A prescriber who prescribes brand drugs when generics are available, or who prescribes high-cost specialty drugs without appropriate clinical criteria, is a target for education and outreach. Prescriber pattern analysis is a powerful tool for reducing unnecessary drug costs.