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The evolving role of pharmacy benefits management firms in a managed care environment.

The next five to seven years will see a major shake-up in the pharmacy benefits management industry. A highly competitive race is underway between independent, retail pharmacy chain-sponsored and pharmaceutical manufacturer-controlled PBMs to see who will develop and monitor prescription drug efficacy protocols that reduce the total costs associated with an episode of illness.

Clinical Protocols↗

Drug formulary commentary: an integrated health systems approach.

Integrated health systems create opportunities and challenges for pharmacists in developing approaches to provision of pharmaceutical care and services. A fundamental area for integration is drug formulary management. This commentary addresses the need for pharmacists in integrated systems to first create a vision of success. From there, pharmacists can capitalize on their expertise in drug formulary management to create and win in terms of quality and cost for the entire system.

Communication↗

Pharmaceutical management strategies of industrialized countries.

Health care costs as a percentage of the gross national product have been increasing in most industrialized countries. As part of the trend, pharmaceutical expenditures also have been rising. In many countries, pharmaceutical costs are the largest single health care expenditure. In an effort to contain rising costs, governments are exploring a variety of pharmaceutical management strategies. These include price controls, restrictive formularies, budget caps, profit controls, and practitioner education.

Budgets↗

Developing and implementing a statewide formulary system: one state's experience.

Prior to the Pennsylvania Department of Public Welfare (DPW) implementing a statewide formulary for its 21 mental health hospitals and mental retardation facilities, each facility had its own drug use policy. In many facilities, drugs were ordered with little or no cost-containment or drug-management consideration. To change drug purchasing and usage policies, a task force was created to develop a state formulary system. The task force appointed a formulary subcommittee to research and make recommendations on issues such as drug selections, formulary substitutions, and nonformulary drug use. The step-by-step process of developing and implementing the Pennsylvania DPW state formulary--including pitfalls and successes--is presented.

Drug Costs↗

Implementation of a pharmacy benefit to a managed Medicaid population.

This paper describes an evaluation of per member per month costs, preauthorization processes, drug utilization, and provider and member educational efforts after one year of managing the pharmaceutical benefit of a former Medicaid population. During TennCare's inaugural year, HMO per member per month pharmacy costs decreased, prior authorization request and call activity decreased, and drug marketshares aligned toward formulary agents. Provider and member acceptance of the restrictive formulary grew as consistent interaction with the HMO became patient-specific.

Age Factors↗

Electronic prescriptions: just what the doctor ordered.

Electronic prescription systems address many of the ills in the current paper-based system of getting drug orders from physicians to pharmacies. This new automation application shows tremendous potential for saving time and money and reducing the chance for medication errors. But many hurdles must be overcome before electronic prescribing is widely used.

Attitude to Computers↗