Managed Care Pharmacy Practices Safeguard Patients and Health Care Resources
Posted on: Wednesday, 29 March 2006, 12:01 CST
Much media attention has recently been focused on the personal accounts of Medicare beneficiaries as they select a Medicare Part D plan and begin filling their first prescriptions. Some have run into commonly used pharmacy benefit management practices that are unfamiliar and therefore confusing.
These procedural aspects of managed care pharmacy practice initially seem to be barriers to access, but they have been developed to protect patients from harm and inappropriate drug use. These practices have been part of the management used by drug benefit plans in the private sector for at least two decades, and have been successful in enhancing quality and imposing restraints on escalating drug costs. In point of fact, only a small percentage of drug plan members are impacted by these limitations.
Two related practices currently receiving some attention are prior authorization, which is designed to promote the appropriate use of medications, and drug utilization review (DUR), which focuses on drug safety. These practices are important, especially in the elder population, where multiple medications are often prescribed for an individual patient by multiple prescribers. Patients not receiving coordinated care through a managed care arrangement could unknowingly be prescribed dangerous or inappropriate dosages. For patients who fill prescriptions in multiple pharmacies, or who do not unfailingly inform all of their physicians of all of the medications that they are actually using at each visit run the risk of adverse drug interactions, overuse or under-utilization of their medications.
"For many Medicare beneficiaries, this is the first time that all of their medications are being systematically reviewed for safety, efficacy and effectiveness," said Judith Cahill, executive director of the Academy of Managed Care Pharmacy. "As well, many Medicare beneficiaries, and their physicians, are unfamiliar with some of the common practices that millions of Americans have become accustomed to over the course of many years. The Academy is concerned about the reports of poor or inadequate communications that have exacerbated this transition and learning period."
Prior authorization is most commonly used for drugs that have a high potential for misuse or inappropriate use. Health plans, employers and government sponsored health care programs, such as Medicare, look for a balance between managing increasing drug costs and providing value to patients. Prior authorization is designed to provide patients with the medication therapy that they need, and ensure that the medications are properly administered, taking into consideration the design of the drug benefit, the needs of the plan sponsor, and all statutory and regulatory requirements. DUR involves a comprehensive review of a patient's prescription and medication data before, during and after dispensing to ensure appropriate therapeutic decision-making and positive patient outcomes. Computerized DUR messages identify inappropriate combinations of drugs and harmful duplicate prescriptions.
Cahill adds, "Efficient and effective use of health care resources can minimize overall medical costs, improve health plan member access to more affordable care and provide an improved quality of life."
The Academy of Managed Care Pharmacy's mission is to empower its members to serve society by using sound medication management principles and strategies to achieve positive patient outcomes. AMCP has more than 4,800 members nationally who provide comprehensive coverage and services to the more than 200 million Americans served by managed care. More news and information about AMCP can be obtained on its website, www.amcp.org.
Contact: Carolyn Stables 703-683-8416 ext 608 Contact via http://www.marketwire.com/mw/emailprcntct?id=E4401A3B3733F83D
SOURCE: AMCP
Source: MARKET WIRE
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