Prescription Drug Coverage

Where We Stand:

The Academy ofManaged Care Pharmacy (AMCP) supports the inclusion of prescription drug coverage in all health care benefit programs, including those administered by government agencies (e.g.,Medicare,Medicaid, and health insurance exchanges). Appropriate access to and use of prescription medications promotes both patient well‐being and the efficient use of medical resources. Access to a comprehensive prescription drug benefit, coupled with proper use of those medications, has been shown to reduce the severity of, and complications arising from, many common illnesses. 

Giving patients access to appropriate medication and making sure these are used in a clinically effective manner is critical in assuring patients’ overall health. Many standard medical protocols now in use have at their core the premise that appropriate access to and use of medications coupled with proper patient monitoring, treatment, counseling, and follow‐up care, help reduce the incidence of complications and improve overall patient outcomes. 

Managed care organizations have been successful in developing best practices when managing drug benefits, optimizing patient outcomes while maintaining the affordability of the benefit as a whole. Prescription drug benefits that are improperly managed can jeopardize patient safety and can drive unnecessary utilization of prescription drugs, leading to higher costs for patients and payers. Government mandates that require coverage of specific medications or classes of medications or that require coverage parity terms, can restrict a managed care organization’s ability to deliver a quality product. Therefore, AMCP supports granting flexibility to managed care organizations to develop clinically sound, evidence‐based benefits free from arduous mandates. 

Failure to provide prescription drug coverage means fewer Americans will have effective drug programs available, thereby diminishing their access to medication therapy and increasing the chance they will require more intensive, costly health care services, such as surgery and/or hospitalization. 

See also:

AMCP position statement on Formularies and Government‐Mandated Pharmacy Benefits

AMCP Where We Stand series: https://www.amcp.org/policy-advocacy/policy-advocacy-focus-areas/where-we-stand-position-statements

Reapproved by the AMCP Board of Directors, February 2017