D-3.3. Estimating Utilization

HHSC pharmacists identify utilization data to develop the estimate. When a more complex analysis is needed, the pharmacist submits a Benefits Management Review (BMR) Request to the HHSC Center for Analytics and Decision Support (CADS). CADS research specialists estimate the number of people who may potentially use the drug by doing the following:

1. Using claims and encounters history to determine possible population
2. Estimating population on the VDP-provided diagnosis codes, comparable procedure codes, and NDCs or related studies
3. Referring to other sources as needed to gather additional information to provide a population estimate