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PubMed1999

Pharmacy risk: is it in your future?

This article discusses how Sutter Health's affiliated medical groups and independent practice associations (IPAs) prepared for entering a pharmacy risk agreement. It should serve as a primer for those providers contemplating pharmacy risk and is written in lay terms. Providers who expect not just to survive, but to thrive, in a capitated environment must approach pharmacy risk agreements with extreme caution.

Actuarial Analysis↗
PubMed1999

Impact of combination therapy on managed care. Based on a presentation by Lisa Latts, MD, MSPH.

The major objectives of managed care are particularly applicable to hypertension, a very common disease that affects about 30% of the adult population. Although managed care organizations know that adequate blood pressure control has a considerable impact on reducing hypertension-related morbidity and mortality, managed care is, at present, doing a generally poor job of monitoring antihypertensive therapy. One of the major reasons for this is the difficulty in gathering the necessary data from administrative sources; only chart review, which is very costly and very time consuming, can provide the data needed. The value of disease management lies in its capacity to optimize clinical and economic outcomes as well as to improve service and quality of life, using inputs such as cost, time, clinical resources, and patient satisfaction. Disease management programs are instituted because they can lead to improved quality of life and reduced costs. While the focus in managed care has traditionally been on promoting risk modification behavior, providing patient education, and encouraging medication compliance, the treatment of hypertension itself has not been a major focus in most disease management programs. Measuring the effectiveness of the hypertension treatment is, however, one of the proposed measures for the Health Plan Employer Data and Information Set (HEDIS 2000) to profile health plan quality. From a managed care perspective, the potential benefits of combination therapy for hypertension include improved blood pressure control and improved patient compliance as a result of needing fewer pills and experiencing fewer side effects with low-dose therapy. Among the obstacles to combination therapy in the managed care setting are the addition of the combinations onto a formulary and lack of acceptance among physicians. Fixed-dose combination therapy with a calcium channel blocker and an angiotensin-converting enzyme (ACE) inhibitor can potentially reduce pharmacy costs if given to patients who are taking both drugs independently and to patients who are taking a calcium channel blocker but should probably also be taking an ACE inhibitor (e.g., patients with diabetes or congestive heart failure). A mini-pharmacoeconomic analysis based on claims data over a 6-month period from HMO Colorado, a health maintenance organization, shows that switching patients on dual therapy with a calcium channel blocker and an ACE inhibitor to 1-pill combination therapy with both agents can result in substantial cost savings.

Antihypertensive Agents↗
PubMed1999

Prescription costs become harder to swallow. Providers and payers get a big dose of reality with explosive spending and patient demand for new drugs.

Hospitals and managed-care organizations know that pharmacy costs are going to keep climbing. It's a question of how much and how quickly they can slow the growth of an expense that has become increasingly hard to swallow. Spending on prescription drugs is rising at 12% per year, more than double the 5% increase in national healthcare expenditures.

Cost Sharing↗
PubMed1999

Selective contracting and patient outcomes: a case study of formulary restrictions for selective serotonin reuptake inhibitor antidepressants.

OBJECTIVES: Many health maintenance organizations (HMOs) have selected 1 or 2 selective serotonin reuptake inhibitors (SSRIs) as their preferred drug for treating depression. This study investigated the effect of "single-drug" formulary restrictions on the likelihood of drug therapy completion for new patients, controlling for initial SSRIs used and other factors. METHODS: Prescription drug and medical record data for 187 patients who were newly prescribed SSRIs were retrieved from a single California group practice consisting of 22 board-certified primary care physicians. The group practice contracted with 2 independent practice association-model HMOs with different SSRI formulary restrictions. A multivariate analysis of drug therapy completion was conducted and 2 sensitivity analyses were performed. Completed therapy was based on the patient having achieved 6 months of uninterrupted therapy at a minimum therapeutic dose. RESULTS: Patients from the HMO with a single preferred SSRI (paroxetine) were 80% less likely to complete therapy than were patients from the HMO with 2 preferred SSRIs (fluoxetine and paroxetine) (odds ratio [OR] = 0.200, 95% confidence interval [CI] = 0.083-0.430). This formulary effect was independent of the initial drug used to treat the patient. Drug selection was also found to affect completion rates. Patients treated with sertraline were significantly less likely to complete therapy than were patients treated with fluoxetine (OR = 0.319, 95% CI = 0.105-0.968). Similar results were found for patients taking paroxetine relative to fluoxetine (OR = 0.357, 95% CI = 0.149-0.853). CONCLUSION: These results suggest that the use of single-product formularies may have unintended consequences on patient completion rates, independent of whether or not the most effective product is selected for preferred formulary status.

Adult↗
PubMed1999

Health economics. Perfect combination.

The assumption by some HAs that a shift from mono to combination drug therapies for HIV results in a proportional increase in drug expenditure, regardless of health gains, is misguided. Methods of calculating anti-HIV drug expenditure have failed to keep up with changing treatment regimes. There is an urgent need to change the way data on antiretroviral use is collected and presented to establish the true cost-effectiveness of new drug regimes.

Anti-HIV Agents↗