The impact of managed care on pharmacy practice

Area of Science:

• Health Economics
• Pharmacy Practice Management
• Managed Care

Background:

• Rising prescription drug costs necessitate cost-containment strategies by managed care organizations (MCOs).
• Pharmacy benefit management companies also seek methods to control escalating medication expenses.

Purpose of the Study:

• To examine the impact of managed care on pharmacy practice.
• To review reimbursement models for managed care prescriptions.
• To outline cost-containment measures for MCOs and pharmacy benefit management.

Main Methods:

• Review of cost-containment strategies employed by MCOs and pharmacy benefit management companies.
• Analysis of cost-reduction approaches for pharmacies.
• Identification of strategies for pharmacist reimbursement.

Main Results:

• MCOs utilize mail order pharmacies, electronic claims, formularies, and generic incentives for cost containment.
• Pharmacies focus on reducing dispensing costs, overhead, and ingredient expenses.
• Demonstrating the value of cognitive services, such as patient counseling, is recommended for pharmacists.

Conclusions:

• Managed care significantly influences pharmacy practice and cost management.
• A multi-faceted approach involving MCOs, pharmacy benefit managers, and pharmacies is crucial for controlling drug costs.
• Pharmacists must advocate for the recognition and reimbursement of their clinical services.