Pharmacy

A few months ago, Medicare officials were worried that insurers and health plans might be reluctant to offer new PPO and prescription drug coverage options created by Medicare reform legislation. Now it looks like the agency's real problem is to help Medicare beneficiaries choose wisely among a multitude of coverage options.

Prior authorization has evolved into a more-efficient process.

HMO pharmacy copay comparison

July DTR Analysis

HMO pharmacy copay comparison

One plan puts Web power to work and reduces call center volume

June DTR Analysis: Uncovering administrative barriers

While the overall cost of injectables is relatively consistent from health plan to health plan, regional differences exist in the total cost of individual therapy classes as a result of PMPM utilization, necessitating payers to develop injectable management programs that are customized for their geographical service area. Examples of these regional differences include the higher incidence of multiple sclerosis in northern states, higher prevalence of older Americans in states such as Florida and Arizona (and the associated higher oncology costs), and infertility costs in states where coverage is state-mandated.

How physician prescribing is controlled.

Just when it looked like nothing could eclipse pharmaceutical costs, Harvard Pilgrim Health Plan found a new cost generator sneaking up, diagnostic imaging, which was increasing an average of 25% a year over the past few years. Much like disease management firms and pharmacy benefit managers, companies such as National Imaging Association (NIA), American Imaging Management (AIM) and MedSolutions have stepped in to help manage the cost of imaging services.

Generics should get a large boost in the next few years as branded drugs accounting for more than $38 billion, including Prevacid, Prevachol, Zocor, Zoloft and Paxil, are expected to come off patent by the end of 2008. With the generic dispensing rate remaining under 42% over the past 10 years, there is room for improvement; savings of nearly 1% by plan sponsors for every 1% increase in the use of generics, according to Express Scripts.

The accreditation process influences quality business improvement and has value beyond an organization seal of approval. Experts say the cost of low quality far exceeds the cost of the accreditation process.

Cost management attributes compared

Cost management attributes compared

OTC and generics help the cause

Group purchasing organizations bring efficiencies

Viral illnesses are notoriously difficult to treat. There are a host of antibiotics to fight bacteria, but until recently, most viruses were treated with over-the-counter analgesics plus supportive measures such as bed rest and fluids.

His story sounds like it's taken from a Norman Rockwell painting. President of RxEOB, Robert Oscar, RPh, grew up living next door to a gentleman who owned a local drugstore.

At Premera Blue Cross of Washington state, a simple brown bag might hold the solution to avoiding adverse drug reactions for patients taking multiple medications.

Forward-thinking plans that leverage knowledge to manage their pharmacy costs will see better returns on their investments, says Jan Berger, MD, senior vice president and chief medical officer for Caremark Rx Inc., a pharmaceutical services company based in Nashville.

April FDA Pipeline

Biologics evaluated for cost effectiveness.

Parkinson's Disease is a chronic, progressive neurological disorder that occurs when neurons in the part of the brain that controls movement start to degenerate. This leads to a shortage of the neurotransmitter dopamine, causing characteristic movement problems.

Pharmacy Benefit Managers (PBMs) are wading through yet another controversy, this one pitting them against retail pharmacies, who claim that mandatory mail service is stifling competition or simply put, stealing away many of the pharmacies' customers. Mail-order prescriptions, however, have long been a cost-saving strategy promoted by PBMs and requested by their employer clients.

Officials at the Centers for Medicare and Medicaid Services (CMS) began smiling last month. They were watching the letters and applications roll in from MCOs--;a sign that seniors will be able to obtain care from a large number of local PPOs (preferred provider organizations) beginning next January.

Patients who receive these added pharmacist services place a very high value on them.

About three years ago I asked a large group of health plan executives if they knew how much they spend annually for ?specialty pharmacy? products. Few could respond, and virtually none had launched any efforts to control the then unknown rapid increase in these costs.Today, this is not the case.

JUST A FEW YEARS AGO, a three-tier formulary was a novelty; now more and more health plans and employers have introduced the design into their pharmacy benefits. The growth in the number of workers covered under a three-tier design has grown from 27% to 63% between 2000 and 2003.

March DTR Analysis: Drug Coverage

BREAST CANCER is the most common cancer found in women, and the second leading cause of cancer deaths in women. More than 200,000 new cases of invasive breast cancer are diagnosed in the United States each year, approximately 77% of them in women over 50 years of age.