Managed Care Pharmacy’s Future: What Health Execs Should Know

MHE PublicationVol 28 No 6
Volume 28
Issue 6

Some of the most amazing things are happening in the delivery of medical care these days. Surgical techniques, new devices, drugs, and diagnostics can treat and cure many medical conditions. Now the only challenge is who pays for these advances and how. More than ever, managed care pharmacy is at the center of healthcare and needs to help design, develop, and implement new solutions to address this challenge.

This special issue of Managed Healthcare Executive, discusses the changing nature of managed care pharmacy and the role it needs to take in curbing healthcare costs. Here are some of my thoughts.

What needs to happen

With the growth of specialty pharmaceuticals, the roles of the physician, pharmacist, and patient need to be redefined and the total cost of care must be evaluated to see what really adds value in medical care. We need to develop new models of care to address the new world of healthcare.  

The administrative costs of medical and pharmacy benefits must decrease and there must be more price transparency as patients begin to act as consumers.

Currently, purchasers measure the effectiveness of PBMs by whether they reduce the unit cost of prescription drugs. Utilization management is also widely used to make sure the right drugs are used by the right patients. Systems and processes for this work are driving physicians and pharmacists crazy.

We need to merge pharmacy claims data with medical claims data and patient reported outcomes to measure drug performance and have value-based contracting.

Managed care pharmacy needs to reinvent itself to make value-based contracting happen on the healthcare financing side.

What’s already happening

It’s encouraging to see that most industry leaders agree that value-based contracting is a top priority. When asked, “What is the biggest opportunity to reduce specialty pharmaceutical costs?” The most popular response among healthcare executives who took our Managed Care Pharmacy Survey 2018 was value-based contracting (see page X). Further, 60% of respondents said value-based contracting with manufacturers is the best coverage strategy for new, innovative therapeutics and biologics. 

It’s also good to see that new players and new technology to deliver healthcare, such as telemedicine, are continuing to grow. The kitchen countertop in the patient’s home is where the action will happen. New technology from Google, Amazon, and others will drive this change.

As younger patients view time and space differently from senior citizens, the roles of physicians and pharmacists will change and the movement of information will be digital. Pharmacist house calls will be used to provide patient supportive care and lead to more collaboration between physician, pharmacist, and patient.

The use of companion diagnostics to drive personalized medicine will become the standard of care for certain diseases.

Lastly the use of data, analytics, and reporting will drive decision making for physicians, pharmacists, and patients in the delivery and financing of healthcare to ensure the best use of resources.

Exciting times are ahead, and managed care pharmacy is well positioned to drive the necessary changes.

Perry Cohen Perry Cohen, PharmD, is a Managed Healthcare Executive editorial advisor and chief executive officer of The Pharmacy Group and the TPG family of companies, which provides services to associations, healthcare and information technology organizations, payers and pharmaceutical companies.


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