From The Field: The changing face of pharmacy benefit design

Health Affairs

Volumn 23, Issue 1, 2004, Pages 194-199

  Malkin, Jesse D ^a   Goldman, Dana P ^a   Joyce, Geoffrey F ^a  

^a RAND CORPORATION   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AMFEBUTAMONE; ANTIHISTAMINIC AGENT; EZETIMIBE; FLUOXETINE; HISTAMINE H2 RECEPTOR ANTAGONIST; HUMAN GROWTH HORMONE; IMATINIB; LANSOPRAZOLE; NONSTEROID ANTIINFLAMMATORY AGENT; OMEPRAZOLE; OXYCODONE; PAROXETINE; PRAVASTATIN; PROTON PUMP INHIBITOR; ROSUVASTATIN; SERTRALINE; SIMVASTATIN; VENLAFAXINE;

CONTROLLED DRUG RELEASE; DRUG COST; DRUG FORMULARY; EMPLOYER; HEALTH CARE COST; HEALTH CARE PLANNING; HEALTH PROMOTION; PHARMACY; PROSPECTIVE PAYMENT; REVIEW; ARTICLE; COST; HEALTH INSURANCE; HUMAN; ORGANIZATION AND MANAGEMENT; UNITED STATES;

DEDUCTIBLES AND COINSURANCE; DRUG COSTS; HEALTH BENEFIT PLANS, EMPLOYEE; HUMANS; INSURANCE, PHARMACEUTICAL SERVICES; UNITED STATES;

EID: 4243073003     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.23.1.194     Document Type: Review

References (23)

1. Novartis Pharmacy Benefit Report: 2002 Facts and Figures (East Hanover, N.J.: Novartis Pharmaceuticals, 2002); and J. Gabel et al., "Job-Based Health Benefits in 2002: Some Important Trends," Health Affairs (Sep/Oct 2002): 143-151.
2. Novartis Pharmacy Benefit Report: 2002 Facts and Figures (East Hanover, N.J.: Novartis Pharmaceuticals, 2002); and J. Gabel et al., "Job-Based Health Benefits in 2002: Some Important Trends," Health Affairs (Sep/Oct 2002): 143-151.
3. G.F. Joyce et al., "Employer Drug Benefit Plans and Spending on Prescription Drugs," Journal of the American Medical Association 288, no. 14 (2002): 1733-1739; K.N. Lohr et al, "Use of Selected Drugs and Procedures," Medical Care 24, no. 9 Supp. (1986): S39-S50; S. Schneeweiss et al., "Outcomes of Reference Pricing for Angiotensin-Converting-Enzyme Inhibitors," New England Journal of Medicine 346, no. 11 (2002): 822-829; and T.S. Rector et al., "Effect of Tiered Copayments on the Use of Preferred Brand Medications," Medical Care 41, no. 3 (2003): 398-406.
4. G.F. Joyce et al., "Employer Drug Benefit Plans and Spending on Prescription Drugs," Journal of the American Medical Association 288, no. 14 (2002): 1733-1739; K.N. Lohr et al, "Use of Selected Drugs and Procedures," Medical Care 24, no. 9 Supp. (1986): S39-S50; S. Schneeweiss et al., "Outcomes of Reference Pricing for Angiotensin-Converting-Enzyme Inhibitors," New England Journal of Medicine 346, no. 11 (2002): 822-829; and T.S. Rector et al., "Effect of Tiered Copayments on the Use of Preferred Brand Medications," Medical Care 41, no. 3 (2003): 398-406.
5. G.F. Joyce et al., "Employer Drug Benefit Plans and Spending on Prescription Drugs," Journal of the American Medical Association 288, no. 14 (2002): 1733-1739; K.N. Lohr et al, "Use of Selected Drugs and Procedures," Medical Care 24, no. 9 Supp. (1986): S39-S50; S. Schneeweiss et al., "Outcomes of Reference Pricing for Angiotensin-Converting-Enzyme Inhibitors," New England Journal of Medicine 346, no. 11 (2002): 822-829; and T.S. Rector et al., "Effect of Tiered Copayments on the Use of Preferred Brand Medications," Medical Care 41, no. 3 (2003): 398-406.
6. G.F. Joyce et al., "Employer Drug Benefit Plans and Spending on Prescription Drugs," Journal of the American Medical Association 288, no. 14 (2002): 1733-1739; K.N. Lohr et al, "Use of Selected Drugs and Procedures," Medical Care 24, no. 9 Supp. (1986): S39-S50; S. Schneeweiss et al., "Outcomes of Reference Pricing for Angiotensin-Converting-Enzyme Inhibitors," New England Journal of Medicine 346, no. 11 (2002): 822-829; and T.S. Rector et al., "Effect of Tiered Copayments on the Use of Preferred Brand Medications," Medical Care 41, no. 3 (2003): 398-406.
7. Novartis Pharmacy Benefit Report, and Gabel et al., "Job-Based Health Benefits in 2002."
8. Novartis Pharmacy Benefit Report, and Gabel et al., "Job-Based Health Benefits in 2002."
9. Novartis Pharmacy Benefit Report.
10. L.A. Goodman, "Snowball Sampling," Annals of Mathematical Statistics 32, no. 1 (1961): 148-170.
11. The fifteen respondents were Becky Cherney, Central Florida Health Care Coalition; Perry Cohen, Pharmacy Group LLC; Helen Darling, Washington Business Group on Health; Michael Dillon, NMHCRX; Gerianne Hap, Eli Lilly; Emma Hoo, Pacific Business Group on Health; David Kaplan, Eli Lilly; Grant Lawless, Amgen; Eric Michael, Mercer Human Resource Consulting; Pete Penna, Formulary Resources; Debi Reissman, Rxperts - Managed Care Consulting; Rob Seidman, WellPoint Health Networks; Christine Simmon, Generic Pharmaceutical Association; and two others who asked not to be identified.
12. National Institute for Health Care Management Research and Educational Foundation, "Prescription Drug Expenditures in 2001: Another Year of Escalating Costs," 6 May 2002, www.nihcm.org/spending2001.pdf (23 October 2003).
13. One respondent observed that unions' bargaining power has limited the ability of some large purchasers to adopt multi-tier cost-sharing structures. Beneficiaries in such plans have weak financial incentives to use low-cost drugs.
14. Generic Pharmaceutical Association, "Frequently Asked Questions," www.gphaonline.org/aboutgenerics/faqs.html (6 November 2003).
15. There were 370 products in clinical development as of March 2002; 800 products are expected to be under development by 2005. CIBC World Markets Equity Research, as cited in Advance-PCS, "Health Improvement Report: An Analysis of Prescription Drug Trends and Evaluation of Methods to Reduce Drug Expenditures," Spring 2002, media.corporate-ir.net/media_files/nsd/advp/ reports/advp051702.pdf (4 June 2003).
16. Several respondents mentioned that cost-effectiveness considerations are taken into account by P&T committees. One respondent stated that cost-effectiveness studies are most likely to sway a P&T committee if the methods are perceived as transparent, objective, and rigorous.
17. B. Martinez, "Pharmacy-Benefit Firms Profit on Generic Drugs," Wall Street Journal, 31 March 2003.
18. Pharmaceutical Research and Manufacturers of America (PhRMA) asserts that such programs violate federal Medicaid law by improperly denying access to medicines for Medicaid patients. A lawsuit, filed 1 July 2003 in the U.S. District Court for the District of Columbia, asks for a preliminary injunction invalidating such a policy in Michigan and in other states considering implementing similar programs.
19. W.E. Smalley et al., "Effect of a Prior-Authorization Requirement on the Use of Nonsteroidal Antiinflammatory Drugs by Medicaid Patients," New England Journal of Medicine 332, no. 24 (1995): 1612-1617.
20. J. Avorn and S.B. Soumerai, "Improving Drug-Therapy Decisions through Educational Out reach: A Randomized Controlled Trial of Academically Based 'Detailing'," New England Journal of Medicine 308, no. 24 (1983): 1457-1463.
21. W.J. Guglielmo, "Rx Cost Control: What's Your Role?" Medical Economics 4, no. 80 (2003): 27.
22. M. Kaufman, "Doctors Hear Alternatives to Drug-Firm Sales Pitches," Washington Post, 5 August 2002.
23. G.M. Carter et al., "Use of Diagnosis-Related Groups by Non-Medicare Payers," Health Care Financing Review (Winter 1994): 127-158.