Managing High Cost Claims with Precision Prescribing

Managing High Cost Claims with Precision Prescribing

Finding the correct treatment may sometimes take years and adverse drug reactions may be inevitable, especially for people suffering from chronic conditions that require long term medication treatment plans. When dealing with these health issues, it is often hard for employees to be in the workplace and if they are able to work, it may reduce their productivity. A simple, cost-effective solution can provide an easy way to find the best medication by taking a precise approach for prescribing.

Finding the right medication is not trivial

pharmacogenetics and precision prescribing

Waking up in the morning and feeling unfit to go to work is a feeling many are familiar with. Most of the absenteeism in the workplace is due to illness or injury related reasons, in fact, it accounts for 70% of missed work days. One study found that every employee will miss approximately two days of work per year due to illness. Also, presentism (working while sick) averaged at nine days per year, can also have effects on worker productivity. Mental illness, in particular, is now the biggest cause of disability worldwide, and with substance abuse disorders, it causes 217 million lost work days due to productivity decline. So, what can be done to reduce the number of work days lost due to illness while managing high cost claims?

One method involves ensuring the most accurate prescription medication is provided to each individual. Heading to the doctor’s office, one would expect nothing less than being provided with the best and most accurate prescription possible to help reduce symptom and resume normal daily activities as fast as possible. However, this process can be much more difficult than one would imagine, as the number of variables that must be taken into account is tremendous.

When considering the complexity involved in how medications interact within the human body, including drug-drug interactions, genetics, environmental factors, and lifestyle factors, it becomes very difficult for healthcare providers to ensure accurate prescriptions are made. Not only is this information vast, but new research is being published all of the time. It is estimated that a doctor would need 627.5 hours per month to keep up to date on current literature, which is close to impossible. This issue is incredibly important due to the huge amount of patients that use prescription medications in the United States. One study found that 48.9% of people use at least one prescription drug. This is particularly important for patients with chronic conditions that require long term medication plans.

Chronic conditions are common and costly

mental health is common among employees

Chronic conditions are common and include, but are not limited to cardiovascular issues, mental health, and chronic pain. Approximately half of all adults (117 million people) had one or more chronic health conditions and a quarter had two or more. These staggering numbers continue to increase due to the increasing age of the population and increased life expectancy. This is alarming due to the fact that approximately 71% of the total health care spending in the United States is associated with chronic conditions.

Due to this high demand for medication and the number of variables that must be taken into account, adverse drug events (ADE) and ineffective prescriptions are common. Every year, there are more than 2 million serious adverse drug reactions that result in the hospitalization of patients, causing over 106,000 deaths annually in the US alone. These reactions are common mainly due to genetic variation between patients and can affect anyone ranging from illness, disability, prescription cascades, and even death.

Although many ADEs are preventable they cost $130 billion annually for the US healthcare system alone. These unnecessary episodes are not the only shortcoming of the current approach to prescribing, as a staggering 50% of people do not respond to their prescribed drugs. Creating a system that can take into account the factors that could lead to these adverse reactions, and analyze which treatments would work best for each patient is needed for people to be able to return to normal daily routines.

Managing high cost claims: Find the best treatments possible for your employees

precision prescribing help employees stay at work

Ensuring employees find the best treatments possible and managing high cost claims, not only can speed up the recovery period but also can have a positive impact on a business’ bottom line. This is because ineffective treatment affects the employee’s health, but also has huge financial cost for employers. For an employer, loss of productivity and increasing healthcare costs can cause a significant burden. A survey of almost 30,000 participants in the US, revealed that health-related loss of productivity time cost employers $225.8 billion per year ($1685 per employee per year). Another study found that after cancer, cardiovascular disease, pain, diabetes, arthritis, and depression generate the highest costs in terms of productivity and medical claims for employer.

In terms of pharmacy and medical claims, employers are facing soaring healthcare spending that is making them think of cost-effective ways to improve health while lowering healthcare costs, such as genetic testing. Healthier workers are more productive and miss fewer days of work. Implementing a simple, cost-effective, evidence-based strategy to manage chronic illnesses is imperative.

So, what would a new strategy for managing high cost claims look like? A new technology of precision prescribing is a method of analyzing variables to ensure high medication efficacy. Improving patient safety and medication effectiveness requires millions of pieces of medical information, computational analysis, and fast usable results. This can be integrated into software that takes these variables into account to provide a comprehensive medication list tailored to each individual.

This method of precision prescribing is powered by the field of pharmacogenetics, the study of the role of inherited and acquired genetic variation in drug response. Biomarkers can help physicians optimize drug selection, dose, and treatment duration and avert adverse drug reactions. It has been shown that 97% of people have genetic variations that affect drug response and that 18% of prescriptions are affected by pharmacogenetics. Due to these factors, incorporating pharmacogenetic information has been shown to reduced ADR’s from 53% to 28%.


The efficacy of prescription medications depends on many variables ranging from genetics to environmental factors. In the current system, it is difficult to ensure that these variables are analyzed to ensure that the right prescription is made. This issue has lead to dangerous adverse effects to medications, as well as medications not being effective for the patient. For an employer, these outcomes can be damaging due to lost productivity and increased health insurance premiums. An easy to use, cost effective method could be a very useful tool in ensuring that medications are prescribed accurately to improve health outcomes and ultimately make sure that employees are healthy and back to work.

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