Managed care organizations: an introduction--Part I of II

Today, managed care organizations operate along a wide spectrum of healthcare delivery models. From staff model HMOs to EPOs, the common element remains the delivery of cost-effective healthcare services to the patient. Implicit in such a system is pharmaceutical care and its related services provided by a pharmacist. Just as the definition or specific delivery model for medical services in managed care has changed since the mid-1950s, pharmacy and pharmaceutical service is different today from our predecessors' practice. Contemporary pharmacist roles and responsibilities continue to change and expand beyond those which existed as little as 1 year ago. As has been accomplished in hospitals, MCO pharmacists are increasingly involved in determining and selecting the best course of rational drug therapy for selected patients' conditions in all managed care settings. This is manifested by drug formularies, drug review programs, clinical practice guidelines, coordinated care committee work, and direct patient counseling. In the next part, the different organizational and professional roles of a pharmacist will be explored.