Pharmacy

The FDA is considering behind-the-counter (BTC) medication availability and how it might improve access to safe and effective drugs.

Only a few months ago, efforts to build a national electronic health information system appeared dead in the water. Now there is growing support on Capitol Hill for legislative action, plus strong statements from the Bush administration backing health information technology (HIT).

What works for retail pharmacy patients should work for mail-order recipients, namely, personalized drug counseling. When consumers pick up their prescriptions at a local pharmacy, they have access to pharmacists who can advise them on how and when to take medications, warn them of potential side effects and discuss generic alternatives.

A recent survey by the Employee Benefit Research Institute found that 70% of those enrolled in consumer-directed health plans (CDHP) say that they consider costs when deciding to see a doctor or filling a prescription as compared with fewer than 40% of those in a comprehensive plan. However, the survey also found that CDHP enrollees were twice as likely to avoid, skip or delay healthcare services.

Groups such as WellPoint are turning specialty pharmacy into a highly beneficial business model for everyone from the non-clinician to physicians.

Today, hospitals and other facilities are implementing forms of pay for performance in previously unimaginable ways. Such programs typically use established ratings methods and indicators to measure levels of quality, then offer incentives or compensation to entities or providers who are rated highly based on these indicators.

Pharmacy Benefits Managers (PBMs) have long gotten a bad rap, taking heat for lack of transparency in their dealings with pharmaceutical manufacturers. Some agreements leave health plans in the dark about the true value of their PBMs. Touting benefits, from clinical-based formularies and lower drug costs and to specialty pharmacy benefits and retail networks, may not be enough today to attract business in a competitive marketplace.

Clinical depression is a major problem in the United States, affecting an estimated 5% to 10% of all adults. Costs for medical care and lost productivity related to depression are estimated at more than $40 billion per year.

When a drug is approved by FDA, there is a large volume of data available for review, but once the drug is being used in the market, new safety data are not as forthcoming, according to Gerald J. Dal Pan, MD, director, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research (CDER), U.S. Food & Drug Administration (FDA).

Health plans are looking for a more integrated approach to managing specialty therapies so they can effectively and efficiently manage the quality of care for the member, as well as the cost to the plan sponsor, say industry experts.

Preventable medication errors are resulting in $3.5 billion in drug-injury related healthcare costs. To address this crisis, the IoM recommends that the entire system move to electronic prescribing (e-prescribing) by 2010.

NATIONAL REPORTS-An opportunity for drug companies to voluntarily provide detailed evidence of their products' cost effectiveness to existing alternatives is showing progress-but is still far from successful, according to industry experts.

PPOS are seeing a continued resurgence in some areas, and in others, are not able to compete effectively with HMOs, industry experts say.

THE ADVENT OF COSTLY biologic drugs for psoriasis hasn't inspired the inappropriate prescriptions many MCOs expected. But that's largely because MCOs are employing a firm hand in managing these drugs early on, educating providers and patients before new drugs come to market and implementing prior authorization (PA) requirements that balance patient access with cost effectiveness. While some policies occasionally require tweaking, sources agree that physicians are not taking these prescriptions lightly.

A value-based formulary takes into account individual illnesses and varies financial incentives determined by how important a medication is to a patient.

Not designed to be used as a stand-alone formulary, reference formulary systems offer a baseline for employers to use to compare their current formulary with one optimized to achieve maximum cost savings and to maintain quality.

A value-based formulary takes into account individual illnesses and varies financial incentives determined by how important a medication is to a patient.

Providing patients with safe, effective and affordable prescription drugs is a continuous challenge for health plans and insurers. These efforts rely heavily on the decisions made by the Food and Drug Administration (FDA) in determining which new drugs come to market and how those medicines perform when used in real-world healthcare settings.

NATIONAL REPORTS-For chronically ill patients, increased cost sharing can be associated with lower rates of drug treatment, less adherence among existing users and more frequent d iscontinuation of therapy, according to research published in a recent issue of the Journal of the American Medical Assn.

As payers have been increasingly impacted by rising drug costs, they have become more creative in plan design by introducing different copay tiers and member incentives to change drug purchasing behavior, say industry watchers.

While your pharmacy benefit program has no doubt been managing utilization for years with core strategies, it's important to review effectiveness often. Below are the proven strategies that payers should analyze frequently in the current market of increasing utilization.

Payers and employers can pay up to $350,000 per patient for just one year of treatment for high-cost conditions such as rheumatoid arthritis. Patients, too, share the burden, in some cases shouldering 50% of the bill in deductibles and co-pays.

Antipsychotics are the fourth largest group of medications prescribed in the United States today, with a collective cost of approximately $10 billion. Newer, second-generation medications represent 90% of the current market, and they cost considerably more than older antipsychotics.

Findings of a study released earlier this year suggest that the average cost of dispensing prescriptions may be higher than the average dispensing fees paid to pharmacies.

Employers are putting more financial burden on employees in the form of higher copays and deductibles, however, in the physician's office, patients' cost concerns usually aren't discussed in advance of a particular treatment.