The session will cover two drug categories and medications commonly used and current trends of fraud, waste and abuse. The four medications include GLP-1 (Ozempic/Mounjaro) and Antivirals combinations (Descovy & Biktarvy). Each drug will cover its directed use by manufacturers and common side effects, this will segue into issues of patient harm being inappropriately prescribed and its financial impact on health plans. Data analytic tactics using patient historical clinical indications to identify potential FWA providers/members and approaches to address outliers. The aftermath of inappropriately prescribing causing pharmacy inventory shortages, diversion, misbranding and counterfeit production by fraudsters for profit.
Learning Objectives:
1) Identifying counterfeit medications mentioned in presentation.
2) Implementation of provider education, recoveries and cost-saving best practices
Eric Renteria
