Managing drug costs: the perception of managed care pharmacy directors.
OBJECTIVE: To examine the perceptions of health plan pharmacy directors about drug costs and utilization drivers, interventions the plans use to control drug expenditures, and strategies considered necessary to permit continued provision of a comprehensive drug benefit. STUDY DESIGN/METHODS: A multipart survey developed and mailed to 500 pharmacy directors of managed care organizations across the country. RESULTS: The survey respondents (response rate = 18%) represented managed care health plans in the following percentages: 49% of respondents were from network/independent practice associations; mixed-model health maintenance organizations (HMOs), 20%; group HMOs, 15%; and staff-model HMOs and network/preferred provider organizations, 8% each. Drug mix and utilization were reported to be the primary drivers of drug expenditures. Half the respondents rated inflation as a somewhat strong cost driver. Interventions the health plans use to control drug expenditures include formularies, generic substitution, preauthorization, manufacturers' rebates, drug benefit design, physician profiling, target drug programs, academic detailing, and tiered copays. With the exception of formulary use, generic substitution, and manufacturers' rebates, which all the plans have instituted, the types of interventions used by the different model types vary widely. More than half the pharmacy directors reported generic substitution, drug benefit design, and differential copays as very effective interventions used to control drug costs. CONCLUSIONS: The majority of pharmacy directors predict continued double-digit increases in drug expenditures over both the short term and the long term. Of the respondents, 91% reported that additional limits and/or exclusions to the benefit design would be necessary to control these increases. To continue providing a comprehensive drug benefit, 54% indicated that they would have to achieve sufficient cost savings in other areas to offset increases in drug costs. (+info)
Wrangling prescription drug benefits: a conversation with Express Scripts' Barrett Toan. Interview by Robert F. Atlas.
Express Scripts, one of the three largest U.S. pharmacy benefit management (PBM) firms, has had one chief executive officer since its founding in the late 1980s. As Barrett Toan prepares to retire (he will remain as nonexecutive chairman), his company and other PBMs have moved onto center stage. The recent surge in drug spending has spawned great interest in PBMs' role, as well as controversy over PBMs' business practices. Implementation of the new Medicare prescription drug benefit depends heavily upon the capabilities that PBMs offer. Toan discusses these matters, plus expectations for the future of his industry-particularly opportunities associated with electronic prescribing. (+info)
Antimicrobial stewardship programs in health care systems.
Antimicrobial stewardship programs in hospitals seek to optimize antimicrobial prescribing in order to improve individual patient care as well as reduce hospital costs and slow the spread of antimicrobial resistance. With antimicrobial resistance on the rise worldwide and few new agents in development, antimicrobial stewardship programs are more important than ever in ensuring the continued efficacy of available antimicrobials. The design of antimicrobial management programs should be based on the best current understanding of the relationship between antimicrobial use and resistance. Such programs should be administered by multidisciplinary teams composed of infectious diseases physicians, clinical pharmacists, clinical microbiologists, and infection control practitioners and should be actively supported by hospital administrators. Strategies for changing antimicrobial prescribing behavior include education of prescribers regarding proper antimicrobial usage, creation of an antimicrobial formulary with restricted prescribing of targeted agents, and review of antimicrobial prescribing with feedback to prescribers. Clinical computer systems can aid in the implementation of each of these strategies, especially as expert systems able to provide patient-specific data and suggestions at the point of care. Antibiotic rotation strategies control the prescribing process by scheduled changes of antimicrobial classes used for empirical therapy. When instituting an antimicrobial stewardship program, a hospital should tailor its choice of strategies to its needs and available resources. (+info)
Pharmacy management approach: how do we align all the incentives?
BACKGROUND: While health care costs continue to rise and shift toward employers, a parallel improvement in health care quality has not been evident. As a means to repair this apparent disconnect, pay for performance (P4P) initiatives are being implemented across the country. OBJECTIVE: To explore the need for P4P in the current state of health care delivery and review the design, components, and results of P4P programs. SUMMARY: In P4P, clinical evidence is used by managed care organizations (MCOs) to drive financial incentives and align physicians and MCO goals, thereby improving delivery of care. At the center of all P4P programs are specific metrics, employed to measure the quality of care by which incentives are provided. These metrics fall into 4 main categories: clinical, patient satisfaction, efficiency, and technology. After metrics are employed and a provider is determined to be deserving of an incentive according to the P4P program in place, several different options exist and vary by plan in terms of incentive type. Primarily, these types of incentives include bonuses, adjustable fee schedules, and withholds. SelectHealth, a nonprofit health insurance company serving members in Utah and Idaho, implemented a primary care incentive program in 2002 for several different conditions and for pharmacy utilization that has been successful to date. CONCLUSIONS: While P4P programs are becoming increasingly common in managed care, challenges still remain, and data on whether these initiatives improve outcomes and manage costs is still limited. (+info)
Pharmacy management strategies for improving drug adherence.
BACKGROUND: Significant gaps in quality pervade U.S. health care, leading to suboptimal care and rising costs. One key factor driving the apparent quality gaps and rising costs in the current health care system is the issue of nonadherence to prescription medications. OBJECTIVE: To describe quality gaps in managed care that are driven by nonadherence to prescription medications and characterize the components of successful pharmacy management strategies for overcoming nonadherence. SUMMARY: Collaborative networks and medication therapy management (MTM) programs are 2 pharmacy management initiatives that are useful in reducing medication nonadherence among plan members. The Pharmacy Quality Alliance has laid the foundation for developing useful pharmacy quality metrics, aggregating data, and reporting to both consumers and pharmacies. At the same time, the National Committee for Quality Assurance has developed MTM measures to monitor pharmacy quality. Both organizations have used Medicare Part D as an impetus for these initiatives in an effort to assess the value of the high-cost investment in prescription drugs resulting from the government mandate. CONCLUSION: Managed care stakeholders should strive toward a valuebased health care system by investing more on appropriate medication use, including initiatives to reduce nonadherence and avoid the high costs of treating severe disease in the future. (+info)
Implementation and evaluation of a web based system for pharmacy stock management in rural Haiti.
Managing the stock and supply of medication is essential for the provision of health care, especially in resource poor areas of the world. We have developed an innovative, web-based stock management system to support nine clinics in rural Haiti. Building on our experience with a web-based EMR system for our HIV patients, we developed a comprehensive stock tracking system that is modeled on the appearance of standardized WHO stock cards. The system allows pharmacy staff at all clinics to enter stock levels and also to request drugs and track shipments. Use of the system over the last 2 years has increased rapidly and we now track 450 products supporting care for 1.78 million patient visits annually. Over the last year drug stockouts have fallen from 2.6% to 1.1% and 97% of stock requests delivered were shipped within 1 day. We are now setting up this system in our clinics in rural Rwanda. (+info)
Academic pharmacy administrators' perceptions of core requirements for entry into professional pharmacy programs.
OBJECTIVES: To determine which basic and social science courses academic pharmacy administrators believe should be required for entry into the professional pharmacy program and what they believe should be the required length of preprofessional study. METHODS: An online survey was sent to deans of all colleges and schools of pharmacy in the United States. Survey respondents were asked to indicate their level of agreement as to whether the basic and social science courses listed in the survey instrument should be required for admission to the professional program. The survey instrument also included queries regarding the optimal length of preprofessional study, whether professional assessment testing should be part of admission requirements, and the respondents' demographic information. RESULTS: The majority of respondents strongly agreed that the fundamental coursework in the basic sciences (general biology, general chemistry, organic chemistry) and English composition should be required for entrance into the professional program. Most respondents also agreed that public speaking, ethics, and advanced basic science and math courses (physiology, biochemistry, calculus, statistics) should be completed prior to entering the professional program. The preprofessional requirements that respondents suggested were not necessary included many of the social science courses. Respondents were evenly divided over the ideal length for preprofessional pharmacy education programs. CONCLUSIONS: Although requirements for preprofessional admission have been changing, there is no consistent agreement on the content or length of the preprofessional program. (+info)
A blueprint for pharmacy benefit managers to increase value.
Pharmacy benefit managers (PBMs) have a unique opportunity to promote health and generate value in the healthcare system. Today, PBMs are largely evaluated on their ability to control costs rather than improve health. Pharmacy benefit managers should be evaluated along 3 dimensions in which they can increase value: (1) use of cost-effective medications, (2) timely initiation of appropriate medication therapy, and (3) adherence to that therapy. Value creation requires the development of integrated data systems, stronger partnerships with patients and physicians, and improved measurement and reporting of results. Incentives for PBMs to promote value should drive innovation and improve health outcomes. (+info)