Concepts in Managed Care Pharmacy

The AMCP Concepts in Managed Care Pharmacy Series is a series of papers written to explain managed care pharmacy terms in plain English, and clearly and concisely describe how these concepts are implemented in the managed care setting.

The below concepts are currently being reviewed by AMCP and revisions will be posted when Board approved. 

Disease Management
Disease management is the concept of reducing health care costs and improving quality of life for individuals with chronic conditions by preventing or minimizing the effects of the disease through integrated care.

Drug Utilization Review
Drug utilization review (DUR) is defined as an authorized, structured, ongoing review of prescribing, dispensing and use of medication.

Electronic Prescribing
E-prescribing is the use of health care technology to improve prescription accuracy, increase patient safety, and reduce costs as well as enable secure, real-time, bi-directional, electronic connectivity between clinicians and pharmacies.

Formulary Management
Formulary management is an integrated patient care process which enables physicians, pharmacists and other health care professionals to work together to promote clinically sound, cost-effective medication therapy and positive therapeutic outcomes.

Maintaining the Affordability of the Prescription Drug Benefit
The purpose of this paper is to explain how managed care organizations (MCOs) are able to secure lower drug prices from pharmaceutical manufacturers.

Medication Errors
Medication errors are among the most common medical errors, harming at least 1.5 million people every year.

Medication Stockpiling
AMCP is concerned about the harmful effects that medication stockpiling couls have on individual patients as well as the population as a whole.

Outcomes Research
Outcomes research is a facet of research that measures results of various medical treatments and/or interventions in patient populations.

Patient Confidentiality
Patient Confidentiality Congress passed the Health Insurance Portability and Accountability Act (HIPAA) in 1996.

Prior Authorization
Implementation of a well-designed prior authorization program optimizes patient outcomes by ensuring that patients receive the most appropriate medications while reducing waste, error and unnecessary prescription drug use.

Specialty Pharmaceuticals
Over the past several years, utilization and cost of specialty pharmacy products have been increasing at a rate substantially greater than that of other pharmaceuticals.

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