What does "utilization management" in pharmacy benefits primarily involve?

Utilization management in pharmacy benefits primarily involves managing the use and costs of medications. This process ensures that medications are used appropriately and effectively while also controlling healthcare expenses. It encompasses strategies such as prior authorization, step therapy, and formulary management to evaluate the necessity and efficacy of prescribed medications before they are dispensed.

By managing utilization, pharmacy benefit managers aim to balance quality care with cost efficiency, ensuring that patients have access to necessary medications without incurring unnecessary expenses. This approach not only helps in reducing healthcare costs but also promotes the safe and effective use of drugs in the treatment regimens of patients.

Increasing the number of medications prescribed would not align with the goal of utilization management, which focuses on appropriate prescribing rather than simply increasing quantity. Additionally, eliminating the need for patient education contradicts the principles of utilization management, as informed patients are crucial for adhering to therapy and understanding their treatment options. Lastly, providing all medications covered under insurance is not a characteristic of utilization management; rather, it involves a selective process to prioritize medications based on clinical effectiveness and cost considerations.