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The effect of pharmaceutical benefits managers: is it being evaluated?
Over the last decade, the number of pharmaceutical benefits managers has increased, and their influence has expanded rapidly. These managers now provide prescription drug coverage to more than 100 million Americans. The effect of pharmaceutical benefits managers on health care delivery remains unclear. We review the development of these organizations, their current role in the delivery of pharmaceutical therapies to patients, and their relationship with pharmaceutical manufacturers. We discuss potential advantages and disadvantages of pharmaceutical benefits manager practices and suggest ways in which these organizations can be made more accountable to the employer groups that hire them.
Narrative review: the U.S. Pharmacopeia and model guidelines for Medicare Part D formularies.
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 includes a provision directing the Secretary of the U.S. Department of Health and Human Services to request that the U.S. Pharmacopeia (USP) develop a list of categories and classes (the USP Model Guidelines) that can be used by prescription drug plans in developing their formularies for the Part D prescription drug benefit. The Centers for Medicare & Medicaid Services (CMS) used the Model Guidelines and USP's related listing, termed the Formulary Key Drug Types, to evaluate prescription drug plan formularies submitted by prescription drug plan sponsors intending to provide the new Part D benefit. This article recounts how USP's all-volunteer Model Guidelines Expert Committee developed the USP Model Guidelines and Formulary Key Drug Types, working under a cooperative agreement with CMS in response to the Secretary's request. The Model Guidelines and Formulary Key Drug Types are updated annually to reflect advances in evidence-based medicine, thereby offering timely guidance to CMS and to prescription drug plans based on USP's demonstrated expertise in setting standards.
Clinical use of the new beta-lactam antimicrobial drugs. Practical considerations for physicians, microbiology laboratories, pharmacists, and formulary committees.
New beta-lactam antimicrobial agents with extended antibacterial activity for gram-negative bacilli are being developed and marketed. These drugs provide major advances, especially for treatment of serious infections caused by multiresistant organisms. Several of the drugs have been marketed and many more will be available. Some of these drugs are considerably more costly than the older beta-lactams. The large number of new antimicrobial drugs coupled with their high costs pose complex problems for physicians, microbiology laboratories, and pharmacists. Community hospitals, large general hospitals, and tertiary care hospitals have different needs for patient care and will need different formats for unbiased education, susceptibility testing, pharmacy stocking, and controlling or monitoring for inappropriate use.
A shared formulary is good for us all.
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Shaping a formulary.
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Nurses' and GPs' views of the nurse prescribers' formulary.
This article presents the findings from the evaluation of nurse prescribing, undertaken in eight demonstration sites since October 1994. The authors examine in particular the nurses' prescribing behaviour and the type of items nurses and GPs would like to see added to the formulary. The opportunities for prescribing and the limitations of the formulary for health visitors and practice nurses are highlighted.
Independent and supplementary prescribing and PGDs.
Types of prescribing for non-medical staff are discussed and clarifications made regarding the current overlap in six forms of prescribing and administration of medication. Differences between independent and supplementary prescribing are explored and the distinction between patient group directions and extended formulary nurse prescribing outlined.
Extended independent and supplementary prescribing: an update.
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New additions in the BNF 1976-78.
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[A proposed open formulary for a managed care program in Mexico. The Therapeutic and Pharmacological Committee of Mexico].
OBJECTIVE: To integrate an open formulary with drug use recommendations in which a physician could find a wide range of therapeutic options for his private practice. MATERIAL AND METHODS: An interdisciplinary medical committee with a high scientific level, reviewed each one of all the drugs available to be sell in Mexico, as part of a Pharmacy Benefit Management & Manage Care program implemented in our country. Each drug was classified according to its active ingredient under one of the following categories: 1) essentials, 2) excluded, and 3) not essentials-not excluded. The decision in each case was based on pure scientific grounds and using an Evidence-Based Medicine analysis. RESULTS: The proposed formulary contains a total of 1106 active ingredients-either unique or in combination-, from which 429 (38.8%) were classified as essentials. About one-out-of-ten drugs (8.7%) currently in use within the private medical practice in Mexico, some of them highly prescribed, were regarded by the committee as excluded due to concerns about their efficacy and/or safety. CONCLUSIONS: On this report a detailed description of the process followed to conform the committee, its objectives an its performing criteria is presented, as well as the bases under which the final list of drugs of the formulary were set.
Liability at issue as firms target drug costs.
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Sen. Pryor's formulary plan attacked by drug industry; other groups are less hostile.
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Operation, formulary decision-making activities of a P & T Committee in a managed care setting.
Managing drug benefits in a Health Maintenance Organization (HMO) is perhaps best accomplished through a formulary, as demonstrated by Kaiser Permanente of Colorado. According to Dr. Jim Adams and Ms. Jackie Richardson, the Chairman and Secretary, respectively, of Kaiser Permanente's P & T Committee, since the advent of their formulary only a few years ago, the cost of drugs has been kept well under control, without jeopardizing the quality of care. Both physician and patient education are critical to the success of a formulary in a managed care system--both monumental tasks for Kaiser Permanente of Colorado considering that prescribers exceed 300 and the number of patients they treat approaches 250,000. What is clear in this exclusive Hospital Formulary interview is that HMOs--long recognized for their ability to control costs--can also provide quality health care for patients who use their facilities.
Sources of drug information used by general practitioners.
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Employers push to manage prescription drug costs.
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A second opinion ... attempt to rationalize an unethical practice.
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Expanding formulary and drug-use review programs.
Enlisting the support and participation of physicians is vital if formulary and drug-use review programs are to achieve their full potential for cost savings and quality improvement.