Managed Care Pharmacy Issues

Recognizing the widespread and devastating nature of the opioid crisis, AMCP formed the Addiction Treatment Advisory Group in 2015 based on the recommendation from the AMCP Partnership Forum, Breaking the Link between Pain Management and Opioid Use Disorder.

AMCP CEO Blog: We live in an interconnected world where the marketplace for all things is global. But we must also make sure the global system works for the benefit of the patients we serve. That includes taking steps to ensure the long-term stability and integrity of our critical pharmaceutical supply chain.

The purpose of this paper is to explain how managed care organizations (MCOs) are able to secure lower drug prices from pharmaceutical manufacturers as part of an effort to control drug expenditures.

Over the past several years, the introduction, utilization and cost share of specialty pharmacy products has been increasing at a rate substantially greater than that of other pharmaceuticals. This paper examines the characteristics of specialty pharmaceuticals; the growth of new expertise to handle and manage these pharmaceuticals; and the needs these products create for patients, health plans and practitioners.

Drug utilization review (DUR) is defined as an authorized, structured, ongoing review of prescribing, dispensing and use of medication. DUR encompasses a drug review against predetermined criteria that results in changes to drug therapy when these criteria are not met.

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. This is achieved by providing prescribers with a secure means of electronically accessing health plan formulary, patient eligibility, and medication history at the point of care and securely transmitting the prescription electronically into the pharmacy’s computer system.

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. Effective use of health care resources can minimize overall medical costs, improve patient access to more affordable care and provide an improved quality of life.

Medication errors are among the most common medical errors, harming at least 1.5 million people every year. The extra medical costs of treating drug-related injuries occurring in hospitals alone are at least to $3.5 billion a year, and this estimate does not take into account lost wages and productivity or additional health care costs.

The Academy of Managed Care Pharmacy (AMCP) is concerned about the harmful effects that medication stockpiling could have on individual patients, as well as the population as a whole. The Academy is providing this document as a means of educating the public about the unintended and potentially harmful results of medication stockpiling, and to remind health care providers of the role that they play in preventing these occurrences.

Population health management (PHM) is a key concept in managed care. Improving population health, enhancing the patient experience, and reducing per capita cost are the primary goals of a philosophy called the Triple Aim. PHM extends beyond healthcare organizations, requiring the cooperation of other types of institutions, such as public health departments and social service entities.

The purpose of outcomes research per the Patient Centered Outcomes Research Institute (PCORI) is to assist patients, clinicians, purchasers and policy makers in making informed health decisions by advancing quality and relevance of evidence. The Agency for Healthcare Research and Quality (AHRQ) defines the purpose of outcomes research as a tool to provide evidence about benefits, risks, and results of treatments so clinicians and patients can make more informed decisions.

Health plans, employers and government-sponsored health care programs are focusing their attention on optimizing patient outcomes through the use of medications that have established evidence of efficacy and safety, while providing the highest value.