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AMCP Publishes Catalog of Quality Pharmacy Indicators

Until recently, pharmacy has been mostly silent in the debate about quality of care. Last year, the nation's largest managed care accrediting organization, the National Committee for Quality Assurance (NCQA), published its latest version of the Health Plan Employer Data and Information Set (HEDIS 3.0). For the first time, HEDIS contained measures and processes related to the delivery of pharmaceutical care in the ambulatory setting.

HEDIS was a first step for pharmacy because it recognized that there are elements of patient care related to medication use that are worthy of quality measurement. But HEDIS has its limitations in the pharmacy arena. There are other barriers as well. Within many managed care organizations, there are health professionals who do not fully understand what pharmacy specifically contributes to the patient care process.

For pharmacy to have an expanded role in the quality dialogue, it must first be able to demonstrate its value to others. To do that, pharmacy must develop the tools necessary to help measure or document quality as it relates to pharmaceutical care.

It is with both of these goals in mind that AMCP has published a groundbreaking new document: the AMCP Catalog of Pharmacy Quality Indicators. Developed by the Quality Task Force of AMCP's Professional Practice Committee, the Catalog is designed to help individuals and organizations establish performance measurements of pharmacy activities as they occur within managed care settings. AMCP believes this bold and exciting document will help health care practitioners and health care organizations in their efforts to assess and improve the quality of pharmaceutical care services provided to managed care enrollees.

The Catalog does not establish specific standards of care that practitioners and organizations must follow. Rather, it should serve as a guide or tool to enable practitioners and organizations to select areas of their practices that are opportune for the development of specific quality or performance measures related to appropriate medication use. Individuals and organizations who wish to focus on measuring or improving the medication treatment of patients can use the Catalog to identify specific areas that are pertinent within their own organizations and patient populations.

AMCP has distributed the Catalog to all AMCP members, as well as to more than 420 outside individuals and organizations. These latter recipients include the state affiliates of two major national pharmacy trade organizations (the American Pharmaceutical Association and the American Society of Health-Systems Pharmacists), the Schools of Pharmacy, health care-related foundations, accrediting bodies, key contacts at federal health agencies, pharmaceutical industry contacts, and the largest HMOs and PBMs.

AMCP encourages members to use the Catalog and share it with others in their organizations who are directly responsible for quality issues, including medical directors, quality assurance directors, and accrediting agency representatives.

For more information about the Catalog, call AMCP at 1-800-TAP-AMCP.

AMCP Issues Position Statement on Therapeutic Interchange

Therapeutic interchange programs have long been integral to managed care pharmacy programs. But the practice has received much criticism in the press in recent months, which in turn has prompted a number of state legislatures to consider enacting new laws to restrict or outlaw the practice altogether.

In response, AMCP recently adopted a new Position Statement supporting the use of therapeutic interchange programs as part of a comprehensive approach to quality, cost-effective patient care. The Position Statement is designed to let consumers, the press, lawmakers and other health professionals know that appropriate therapeutic interchange programs benefit patients by allowing pharmacists and other qualified health professionals to use their professional judgment to determine which drug therapies are most likely to result in good clinical outcomes for patients.

The full text of the Position Statement appears below:

AMCP Position Statement on Therapeutic Interchange

The Academy of Managed Care Pharmacy (AMCP) supports the use of therapeutic interchange programs as a part of a comprehensive approach to quality, cost-effective patient care.

Therapeutic interchange is the practice of replacing, with the prescribing physician's approval, a prescription drug originally prescribed for a patient with a prescription drug that is its therapeutic equivalent. Two or more drugs are considered therapeutically equivalent if they can be expected to produce identical levels of clinical effectiveness and sound medical outcomes in patients.

Therapeutic interchange programs are used in health care delivery systems that coordinate the prescription drugs patients receive to optimize patient care. These systems often use formularies which list preferred drugs as a prescribing guide for physicians in cases where alternative drug products are available to treat a particular patient's condition. Therapeutic interchange programs and formularies are commonly used by hospitals, managed health care plans like HMOs, and retail pharmacy networks administered by health plans or pharmacy benefit management companies (PBMs).

Therapeutic interchange programs are guided by clinically-based prescribing guidelines. These programs are developed and administered by a team of physicians, pharmacists, and other medical practitioners who are experts in the diagnosis and treatment of disease. The programs are designed to work in conjunction with other tools that health care professionals use to promote quality medical results.

Using therapeutic interchange offers several advantages:

• Value to patients. When therapeutic interchange occurs, physicians and other health care experts have determined that patients will experience the same or improved clinical outcomes with the replacement drug. The replacement drug may be more convenient for the patient to take. For example, a patient is more likely to take all of the drug prescribed if he or she is moved to a therapeutically equivalent product that only needs to be taken twice a day rather than four times a day. A product that causes uncomfortable side effects may be replaced with one that does not. A new drug that offers improved therapeutic outcomes may replace an older remedy. A patient is generally less likely to miss doses, and thereby get the full clinical benefit of the prescription, if the drug is convenient to use, causes fewer side effects, or provides improved control or relief of their condition.

• Added medical benefit. A replacement drug may be preferable because it is expected to provide a long-term added benefit while still effectively treating the short-term problem. For example, alternative drugs to treat high blood pressure may or may not diminish the risk of heart attacks. Therapeutic interchange programs would allow the health care professional to use the more effective of the two.

• Affordability. A replacement drug that is therapeutically equivalent might simply cost less. Once two drugs are determined to result in the same positive outcomes for the patient, it makes sense for the hospital, health plan, or pharmacy network to use the less expensive alternative.

  However, therapeutic interchange is not always about lower drug costs. Therapeutic interchange often occurs when overall health care savings can be achieved. Replacing one drug with a more expensive one may result in fewer treatment failures, better patient adherence to the treatment plan, and fewer side effects. Such efficient use of medical resources helps keep medical costs down, improves the patient�s access to more affordable health care, and enhances the patient's quality of life.

Adopted by the Board of Directors of the
Academy of Managed Care Pharmacy
on September 13, 1997.