Pharmacy

One of the main criticisms of consumer-directed health plans questions whether members avoid needed medications to save money

Pfizer-Wyeth union is just another example of consolidation in the pharma industry.

Lobbying efforts by the pharmaceutical industry and timing concerns have prevented CMS from requiring that all Part D plans move to pass-through pricing

WellPoint sanctions might be indicative of deeper oversight problems in Medicare.

Although there are barriers to childhood and adult vaccines, benefits likely outweigh the risks, so health plans must be in the driver's seat as far as education and delivery of care.

The first step towards creating an effective market access function is to develop a clear understanding of the needs and perspectives of the various stakeholders in each individual market

Two pricing bases could be identified as potential future replacements for AWP, namely average sales price (ASP) and average manufacturer price (AMP)

Pharmacogenomics offer value measures to MCOs as specialty drug costs skyrocket.

CMS is sending a message that all prescribers must begin using electronic tools to increase safety and reduce costs. Commerical payers are onboard.

PPIs and H2 -receptor blockers are standard treatment for peptic ulcers and GERD, but lifestyle changes and OTC products can help

If MAC lists were not in place, prices for drugs would vary dramatically. Discounts for generic drugs would also decrease significantly.

Does it make sense to treat children for conditions, such as high cholesterol, type 2 diabetes and hypertension, with drugs that have only been approved for adults? If the potential benefit to the child is outweighed by the risk of harm or adverse events, then it makes sense, experts say.

Moving forward, the challenge for health plans and their clients will be to create value as opposed to simply shifting costs to enrollees. Creative solutions abound.

Drug store consolidation leads to increased pressure on retail pharmacies -- and certain drug store chains will not survive

Will generic drugs, patent expirations, safety issues and a dry pipeline for high-incident diseases make room for a new drug paradigm?

Specialty pharmacy as a managed benefit has arrived at the same place pharmacy benefit management was several years ago (offering open formularies, flat co-pays, etc.). Yet little is being done to address specialty pharmacy as a managed benefit.

A recent online survey from Serono Injectables Digest, which includes data from 83 health plans, looked at the challenges and strategies of managing specialty pharmacy, provider reimbursement and cost sharing.

Drug trend for 2007 was 2%, the lowest year-over-year trend since Medco began tracking it in 1999, according to the company. While the drug cost trend is small in terms of overall healthcare dollars spent, it was at one time rising at a rate more than double the rate of inflation, according to Lon Castle, MD, senior director, department of medical and analytical affairs at Medco.

Employers are more than just concerned about the rising costs of prescription drugs-they're ready to stem the tide, according to industry experts.

How much attention is being paid to abuse of prescription drugs? One group, pharmacy benefit managers, are beginning to take a closer look by creating programs to identify members who may be abusing prescription drugs.

Using drugs for conditions other than what's on the label is not new, but it may receive more encouragement if draft guidance from the Food & Drug Administration (FDA) is approved. Allowing more off-label use might also increase payers' pharmacy costs.

MEDICATION THERAPY Management (MTM) services introduced in 2006 under Medicare Part D have prompted pharmacists to adopt expanded roles in the commercial setting, such as performing a comprehensive medication review and monitoring a patient's response to therapy. One of the main caveats, however, is the lack of standardized reimbursement for pharmacists' services.

National Reports-Wal-Mart's recent announcement that it plans to enter the pharmacy benefits arena has perked up a few ears in the industry.

Studies show that patients with behavioral health conditions are less apt to be compliant with medications than other patients, but many of their reasons for non-compliance are equally applicable to all drugs.

Studies show that patients with behavioral health conditions are less apt to be compliant with medications than other patients, but many of their reasons for non-compliance are equally applicable to all drugs.