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Automated drug reviews promise comp savings; industry cautious of AI
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Business Insurance
Automated drug reviews promise comp savings; industry cautious of AIAutomated prescription-review tools are helping workers compensation claims administrators identify high-priced drugs, flag polypharmacy risks and enforce clinical rules, but experts caution that the technology must not replace individualized review.
Interventions involving so-called opportunistic products generated average savings of $915 per prescription, nearly four times the savings from other clinical interventions, Enlyte said.
For clients using automated decision rules, 49% of opportunistic-product savings required no claims examiner intervention.
Enlyte uses rules and clinical messages developed and maintained by pharmacists, not artificial intelligence, said Nikki Wilson, the company’s Omaha, Nebraska-based senior director of clinical pharmacy services.
A pharmacist can contact the prescriber, and any change remains a clinical decision.