Systematic analysis of outcomes evaluations applied to drug management programs

American Journal of Managed Care

Volumn 14, Issue 11 SPEC. ISS., 2008, Pages

  McAdam Marx, Carrie ^a,b   Schaaf, David T ^c   Holtorf, Anke Peggy ^a,b   Eng, Benjamin ^c   Oderda, Gary M ^a,b  

^a UNIVERSITY OF UTAH   (United States)

^b Millcreek Outcomes Group   (United States)

^c PFIZER INC   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CLINICAL ASSESSMENT; ECONOMICS; GOVERNMENT; HEALTH CARE COST; HEALTH CARE MANAGEMENT; HEALTH CARE PLANNING; HEALTH INSURANCE; HEALTH PROGRAM; MANAGED CARE; MEDICARE; OUTCOME ASSESSMENT; PRIORITY JOURNAL; REVIEW; UNITED STATES;

HUMANS; MANAGED CARE PROGRAMS; MEDICATION THERAPY MANAGEMENT; OUTCOME AND PROCESS ASSESSMENT (HEALTH CARE); UNITED STATES;

EID: 56749106193     PISSN: 10880224     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (88)

1. Taguchi G. Introduction to Quality Engineering. NewYork, NY. UNIPAB; 1986.
2. Institute of Medicine. Measuring the Quality of Health Care: A Statement by the National Roundtable on Health Care Quality. Washington, DC: National Academy Press; 1999.
3. Agency for Health Care Research and Quality. AHRQ Quality Indicators. http://www.qualityindicators.ahrq.gov/. 2008.
4. Academy of Managed Care Pharmacy. The AMCP Format for Formulary Submissions. Version 2.1. http://www.fmcpnet.org/cfr/waSys/f.cfc? method=getListFile&id=A2D0F502. Accessed October 20, 2008.
5. National Quality Forum. National voluntary consensus standards for the reporting of therapeutic drug management quality. http://www.fmcpnet.org/ cfr/waSys/%20f.cfc?method=getListFile&id=A2D0F502. Accessed October 25, 2006.
6. National Business Coalition on Health. eValue8 Health Care. http://www.evalue8.org/eValue8/index.cfm. Accessed October 25, 2006.
7. Pharmacy Benefit Management Accreditation. URAC. http://www.pbm.urac.org/files/URAC-PBM-Brochure.pdf. Accessed October 14, 2007.
8. Abourjaily P, Gouveia WA, Selker HP, Zucker DR. Evaluating the nondrug costs of formulary coverage restrictions. Manag Care. 2005;14(8):50-57, 62.
9. Abughosh SM, Kogut SJ, Andrade SE, Larrat P, Gurwitz J. Persistence with lipid-lowering therapy: influence of the type of lipid-lowering agent and drug benefit plan option in elderly patients. J Manag Care Pharm. 2004;10(5):404-411.
10. Adams AS, Soumerai SB, Ross-Degnan D. Use of antihypertensive drugs by Medicare enrollees: does type of drug coverage matter? Health Aff (Millwood). 2001;20(1):276-286.
11. Adams AS, Soumerai SB, Ross-Degnan D. The case for a Medicare drug coverage benefit: a critical review of the empirical evidence. Annu Rev Public Health. 2001;22:49-61.
12. Artz MB, Hadsall RS, Schondelmeyer SW. Impact of generosity level of outpatient prescription drug coverage on prescription drug events and expenditure among older persons. Am J Public Health. 2002;92(8):1257- 1263.
13. Berger J. Economic and clinical impact of innovative pharmacy benefit designs in the management of diabetes pharmacotherapy. Am J Manag Care. 2007;13(suppl 2):S55-S58.
14. Briesacher B, Kamal-Bahl S, Hochberg M, Orwig D, Kahler KH. Three-tiered-copayment drug coverage and use of nonsteroidal antiinflammatory drugs. Arch Intern Med. 2004;164(15):1679-1684.
15. Brixner DI, Joish VN, Odera GM, Avey SG, Hanson DM, Cannon HE. Effects of benefit design change across 5 disease states. Am J Manag Care. 2007;13(6, pt 2):370-376.
16. Bukstein DA, Cherayil GA, Gepner AD, Luskin AT, Kooistra JB, Olson RM. The economic burden associated with prior authorizations in an allergist office. Allergy Asthma Proc. 2006;27(2):119-122.
17. Carroll NV, Brusilovsky I, York B, Oscar R. Comparison of costs of community and mail service pharmacy. J Am Pharm Assoc. 2005;45(3):336-343.
18. Christian-Herman J, Emons M, George D. Effects of generic-only drug coverage in a Medicare HMO. Health Aff (Millwood). 2004;(suppl web exclusives):w4-w455-w468.
19. Cox ER, Jemigan C, Coons SJ, Draugalis JL. Medicare beneficiaries' management of capped prescription benefits. Med Care. 2001;39(3):296-301.
20. Cox E, Henderson R, Motheral B. Health plan member experience with point-of-service prescription step therapy. J Manag Care Pharm. 2004;10(4):291-298.
21. Desselle SP. Determinants of satisfaction with prescription drug plans. Am J Health Syst Pharm. 2001;58(12):1110-1119.
22. Dunn JD, Cannon HE. Effects of a polypharmacy edit and reduced quantity limits on the utilization of triptans and overall costs in an integrated health system. Manag Care Interface. 2006;19(5):46-51.
23. Etemad LR, Hay JW. Cost-effectiveness analysis of pharmaceutical care in a Medicare drug benefit program. Value Health. 2003;6(4):425-435.
24. Fairman KA, Motheral BR, Henderson RR. Retrospective, long-term follow-up study of the effect of a three-tier prescription drug copayment system on pharmaceutical and other medical utilization and costs. Clin Ther. 2003;25(12):3147-3161.
25. Feldman SR, Fleischer AB Jr, Chen GJ. Is prior authorization of topical tretinoin for acne cost effective? Am J Manag Care. 1999;5(4):457-463.
26. Fink KS, Byrns PJ. Changing prescribing patterns and increasing prescription expenditures in Medicaid. Ann Fam Med. 2004;2(5):488-493.
27. Fischer MA, Schneeweiss S, Avom J, Solomon DH. Medicaid prior-authorization programs and the use of cyclooxygenase-2 inhibitors. N Engl J Med. 2004;351(21):2187-2194.
28. Fischer MA, Avom J. Economic consequences of underuse of generic drugs: evidence from Medicaid and implications for prescription drug benefit plans. Health Serv Res. 2003;38(4):1051-1064.
29. Garrett DG, Bluml BM. Patient self-management program for diabetes: first-year clinical, humanistic, and economic outcomes. J Am Pharm Assoc (2003). 2005;45(2):130-137.
30. Gershovich OE, Billups SJ, Delate T, Hoffman CK, Carroll N. Assessment of clinical, service, and cost outcomes of a conversion program of sumatriptan to rizatriptan ODT in primary care patients with migraine headaches. J Manag Care Pharm. 2006;12(3):246-253.
31. Gibson TB, Ozrninkowski RJ, Goetzel RZ. The effects of prescription drug cost sharing: a review of the evidence. Am J Manag Care. 2005;11(11):730-740.
32. Gibson TB, Mark TL, McGuigan KA, Axelsen K, Wang S. The effects of prescription drug copayments on statin adherence. Am J Manag Care. 2006;12(9):509-517.
33. Gibson TB, Mark TL, Axelsen K, Baser O, Rublee DA, McGuigan KA. Impact of statin copayments on adherence and medical care utilization and expenditures. Am J Manag Care. 2006;12(spec no):SP11-SP19.
34. Gilman BH, Kautter J. Consumer response to dual incentives under multi-tiered prescription drug formularies. Am J Manag Care. 2007;13(6, pt 2):353-359.
35. Goldman DP, Joyce GF, Karaca-Mandic P. Varying pharmacy benefits with clinical status: the case of cholesterol-lowering therapy. Am J Manag Care. 2006;12(1):21-28.
36. Harris BN, West DS, Johnson JT, Hong SH, Stowe CD. Effects on the cost and utilization of proton pump inhibitors from adding over-the-counter omeprazole to drug benefit coverage in a state employee health plan. J Manag Care Pharm. 2004;10(5):449-455.
37. Hartung DM, Touchette DR, Ketchum KL, Haxby DG, Goldberg BW. Effects of a prior-authorization policy for celecoxib on medical service and prescription drug use in a managed care Medicaid population. Clin Ther. 2004;26(9):1518-1532.
38. Hartung DM, Ketchum KL, Haxby DG. An evaluation of Oregon's evidence-based Practitioner-Managed Prescription Drug Plan. Health Aff (Millwood). 2006;25(5):1423-1432.
39. Hillman AL, Pauly MV, Escarce JJ, et al. Financial incentives and drug spending in managed care. Health Aff (Millwood). 1999;18(2): 189-200.
40. Hsu J, Price M, Huang J, et al. Unintended consequences of caps on Medicare drug benefits. N Engl J Med. 2006;354(22):2349-2359.
41. Huskamp HA, Deverka PA, Epstein AM, Epstein RS, McGuigan KA, Frank RG. The effect of incentive-based formularies on prescription-drug utilization and spending. N Engl J Med. 2003;349(23):2224-2232.
42. Huskamp HA, Deverka PA, Epstein AM, et al. Impact of 3-tier formularies on drug treatment of attention-deficit/hyperactivity disorder in children. Arch Gen Psychiatry. 2005;62(4):435-441.
43. Johnson RE, Goodman MJ, Hombrook MC, Eldredge MB. The effect of increased prescription drug cost-sharing on medical care utilization and expenses of elderly health maintenance organization members. Med Care. 1997;35:1119-1131.
44. Johnsrud M, Lawson KA, Shepherd MD. Comparison of mailorder with community pharmacy in plan sponsor cost and member cost in two large pharmacy benefit plans. J Manag Care Pharm. 2007;13(2):122-134.
45. Joyce GF, Escarce JJ, Solomon MD, Goldman DP. Employer drug benefit plans and spending on prescription drugs. JAMA. 2002;288(14):1733-1739.
46. Kamal-Bahl S, Briesacher B. How do incentive-based formularies influence drug selection and spending for hypertension? Health Aff (Millwood). 2004;23(1):227-236.
47. Kessler RC, Cantrell CR, Berglund P, Sokol MC. The effects of copayments on medication adherence during the first two years of prescription drug treatment. J Occup Environ Med. 2007;49(6):597-609.
48. Landon BE, Rosenthal MB, Normand SL, et al. Incentive formularies and changes in prescription drug spending. Am J Manag Care. 2007;13(6, pt 2):360-369.
49. Landsman PB, Yu W, Liu X, Teutsch SM, Berger ML. Impact of 3-tier pharmacy benefit design and increased consumer cost-sharing on drug utilization. Am J Manag Care. 2005;11(10):621-628.
50. Lurk JT, DeJong DJ, Woods TM, Knell ME, Carroll CA. Effects of changes in patient cost sharing and drug sample policies on prescription drug costs and utilization in a safety-net-provider setting. Am J Health Syst Pharm. 2004;61(3):267-272.
51. Mager DE, Cox ER. Relationship between generic and preferred-brand prescription copayment differentials and generic fill rate. Am J Manag Care. 2007;13(6, pt 2):347-352.
52. Mahoney JJ. Lowering patient drug acquisition costs to improve health outcomes and costs. Manag Care Interface. 2006;19(4):13.
53. McCombs JS, Shi L, Stimmel GL, Croghan TW. A retrospective analysis of the revocation of prior authorization restrictions and the use of antidepressant medications for treating major depressive disorder. Clin Ther. 2002;24(11):1939-1959.
54. Meissner BL, Moore WM, Shinogle JA, Reeder CE, Little JM. Effects of an increase in prescription copayment on utilization of low-sedating antihistamines and nasal steroids. J Manag Care Pharm. 2004;10(3):226-233.
55. Meissner B, Dickson M, Shinogle J, Reeder CE, Belazi D, Senevirante V. Drug and medical cost effects of a drug formulary change with therapeutic interchange for statin drugs in a multistate managed Medicaid organization. J Manag Care Pharm. 2006;12(4):331-340.
56. Mojtabai R, Olfson M. Medication costs, adherence, and health outcomes among Medicare beneficiaries. Health Aff (Millwood). 2003;22(4):220-229.
57. Motheral BR, Henderson R. The effect of a copay increase on pharmaceutical utilization, expenditures, and treatment continuation. Am J Manag Care. 1999;5(11):1383-1394.
58. Motheral B, Fairman K. Effect of a three-tier prescription copay on pharmaceutical and other medical utilization. Med Care. 2001;39(12):1293-1304.
59. Motheral BR, Henderson R, Cox ER. Plan-sponsor savings and member experience with point-of-service prescription step therapy. Am J Manag Care. 2004;10(7, pt 1):457-464.
60. Motheral BR, Heinle SM. Predictors of satisfaction of health plan members with prescription drug benefits. Am J Health Syst Pharm. 2004;61(10):1007-1014.
61. Murawski MM, Abdelgawad T. Exploration of the impact of preferred drug lists on hospital and physician visits and the costs to Medicaid. Am J Manag Care. 2005;11(spec no):SP35-SP42.
62. Nair KV, Ganther JM, Valuck RJ, McCollum MM, Lewis SJ. Impact of multi-tiered pharmacy benefits on attitudes of plan members with chronic disease states. J Manag Care Pharm. 2002;8(6):477-491.
63. Nair KV, Wolfe P, Valuck RJ, McCollum MM, Ganther JM, Lewis SJ. Effects of a 3-tier pharmacy benefit design on the prescription purchasing behavior of individuals with chronic disease. J Manag Care Pharm. 2003;9(2):123-133.
64. Oh T, Mehta SS, Bonanno C. Managed care organization's experience with a therapeutic conversion program in hypertensive patients. Am J Health Syst Pharm. 1999;56(Jun):P-51.
65. Olson BM, Malone DC, Zachary WM, Coons SJ. Consumer understanding and satisfaction associated with a 3-tier prescription drug benefit. J Manag Care Pharm. 2004;11(6):480-492.
66. Panzer PE, Regan TS, Chiao E, Sames MW. Implications of an SSRI generic step therapy pharmacy benefit design: an economic model in anxiety disorders. Am J Manag Care. 2005;11(12 suppl):S370-S379.
67. Rector TS, Finch MD, Danzon PM, Pauly MV, Manda BS. Effect of tiered prescription copayments on the use of preferred brand medications. Med Care. 2003;41(3):398-406.
68. Richards K, Johnsrud M, Shepherd M. A review of prior authorization programs: antihemophilic, antineoplastic, and antiretroviral agents. The Center for Pharmacoeconomic Studies. http://www.utexas.edu/pharmacy/ research/institutes/pharmacoeconomics/pareport.pdf. Accessed October 13, 2008.
69. Richerson MA, Downs JR, Remund D. Economic and clinical outcomes following application of a cholesterol population model in a closed class formulary decision. Am J Health Syst Pharm. 2001;58(Jun):P-39E.
70. Sansgiry SS, Sikri S, Kawatkar A. Consumer knowledge and perceptions of formularies. Manag Care Interface. 2004;17(1): 21-26,30.
71. Spence MM, Hui R, Chan J. Cost reduction strategies used by elderly patients with chronic obstructive pulmonary disease to cope with a generic-only pharmacy benefit. J Manag Care Pharm. 2006;12(5):377-382.
72. Sprague MS, Gray DR. Impact of a formulary switch from amlodipine to felodipine at a VA medical center. Am J Health Syst Pharm. 1998;55(Dec):P-424E.
73. Sullivan PW, Nair KV, Patel BV. The effect of the Rx-to-OTC switch of loratadine and changes in prescription drug benefits on utilization and cost of therapy. Am J Manag Care. 2005;11(6):374-382.
74. Sweet BV, Stevenson JG. Pharmacy costs associated with non-formulary drug requests. Am J Health Syst Pharm. 2001;58(18): 1746-1752.
75. Taira DA, Wong KS, Frech-Tamas F, Chung RS. Copayment level and compliance with antihypertensive medication: analysis and policy implications for managed care. Am J Manag Care. 2006;12(11): 678-683.
76. Thiebaud P, Patel BV, Nichol MB, Berenbeim DM. The effect of switching on compliance and persistence: the case of statin treatment. Am J Manag Care. 2005;11(11):670-674.
77. Thomas CP, Wallack SS, Lee S, Ritter GA. Impact of health plan design and management on retirees' prescription drug use and spending, 2001. Health Aff. 2002;Jul-Dec;Suppl Web Exclusives:W408-W419.
78. Trygstad TK, Hansen RA, Wegner SE. Evaluation of product switching after a state Medicaid program began covering loratadine OTC 1 year after market availability. J Manag Care Pharm. 2006;12(2):108-120.
79. Tseng CW, Brook RH, Keeler E, Mangione CM. Impact of an annual dollar limit or "cap" on prescription drug benefits for Medicare patients. JAMA. 2003;290(2):222-227.
80. Tseng CW, Brook RH, Keeler E, Steers WN, Mangione CM. Cost-lowering strategies used by Medicare beneficiaries who exceed drug benefit caps and have a gap in drug coverage. JAMA. 2004;292(8):952-960.
81. Tucker G, Moore A, Avant D, Monteiro M. A cost analysis of four benefit strategies for managing a Cox-II inhibitor. J Manag Care Pharm. 2001;7:224-227.
82. Wilson J, Axelsen K, Tang S. Medicaid prescription drug access restrictions: exploring the effect on patient persistence with hypertension medications. Am J Manag Care. 2005;11(spec no):SP27-SP34.
83. Yokoyama K, Yang W, Preblick R, Frech-Tamas F. Effects of a step-therapy program for angiotensin receptor blockers on antihypertensive medication utilization patterns and cost of drug therapy. J Manag Care Pharm. 2007;13(3):235-244.
84. Zeber JE, Grazier KL, Valenstein M, Blow FC, Lantz PM. Effect of a medication copayment increase in veterans with schizophrenia. Am J Manag Care. 2007;13(6, pt 2):335-346.
85. Deming WE. Quality and the required style of management: The need for change. Journal for Quality and Participation. 1988;11(1):48-49.
86. Hadley J. Cost Containment Strategies for Prescription Drugs: Assessing the Evidence in the Literature. March 2005. Kaiser Family Foundation report 7295. http://www.kff.org/rxdrugs/7295.cfm. Accessed September 30, 2008.
87. MacKinnon NJ, Kumar R. Prior authorization programs: a critical review of the literature. J Manag Care Pharm. 2001;7(4):297-302.
88. Goldman DP, Joyce GF, Zheng Y. Prescription drug cost sharing: associations with medication and medical utilization and spending and health. JAMA. 2007;298(1):61-69.