Topical Medication Trends
Examining utilization and spend across in-network and out-of-network channels captures the full scope of topical prescribing patterns. While in-network data reflects the effectiveness of clinical controls, out-of-network topical trends expose significant factors that complicate cost containment. Together, these perspectives reveal where topical spend is concentrated, and where intervention can deliver meaningful savings.
5 Warning Signs in Demand Packages that Need a Closer Look
Demand packages can span hundreds of pages, with medical records, bills and supporting documentation that can take a significant amount of time to sort through. Within that volume of information, important treatment, billing and causation details may be scattered across multiple documents and providers, making the full picture hard to see.
P&C Expert Forum: Getting Ahead of Social Inflation and Nuclear Verdicts
Explore how social inflation, nuclear verdicts, rising medical costs and evolving litigation trends are reshaping auto casualty claims and claim severity.
The Road Ahead for Auto Medical Cost Management
Auto medical costs are showing encouraging signs of stability after several years of rising severity, but maintaining that progress may be the bigger challenge. In the latest Enlyte Envision podcast, Ed Olsen and Michele Hibbert explore findings from the auto casualty section of the Enlyte Envision Trends Report and what they mean for insurers.
Fewer Prescriptions, Bigger Price Tags
Prescription utilization in workers’ comp continues to decline, but that doesn’t mean drug costs are no longer a concern. In fact, the latest Enlyte Drug Trends Report finds a small number of high-cost prescriptions are creating an outsized impact. In today’s Enlyte Envision podcast, Brian Allen explores what’s driving these costs, how some providers are exploiting gaps in the system and what states can do to rein in abusive pricing.
Key Implementation Considerations from Kentucky's New PIP Fee Schedule
For decades, Kentucky's no-fault auto system operated without a dedicated Personal Injury Protection (PIP) medical fee schedule. That changed with the enactment of House Bill 627, which established a new reimbursement framework for PIP medical benefits by incorporating Kentucky workers' compensation fee schedule rates.
In-Network and Out-of-Network Trends
This analysis provides a comprehensive examination of prescription utilization across both in-network and out-of-network channels including retail pharmacies, mail-order services, and paper-based medical bill submissions. This dual-lens approach captures the full prescription landscape that extends beyond traditional pharmacy benefit management reporting, revealing critical cost and utilization patterns across all jurisdictions. While in-network channels demonstrate the real-time effectiveness of integrated clinical controls and cost management strategies, out-of-network data, often representing acute treatment episodes captured through medical bill review, exposes significant cost management opportunities and pricing anomalies. Together, these perspectives illuminate where pharmacy dollars are spent, how prescriptions are managed, and where targeted interventions can drive the greatest impact on both clinical outcomes and costs.
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