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Effective strategies for managing pharmacy benefits
1Merck-Medco Managed Care LLC, Franklin Lakes, New Jersey, USA. david_jacobson@merck.com
Summary
Effective pharmacy benefit plan strategies can control rising prescription drug costs. These include formulary management, mail-service options, and review programs to maintain quality and satisfaction.
Area of Science:
- Healthcare Management
- Pharmaceutical Economics
Background:
- Prescription drug expenditures represent a significant and rapidly escalating component of overall healthcare spending.
- Pharmacy benefit plans face increasing pressure to manage costs without compromising patient care or satisfaction.
Purpose of the Study:
- To outline effective strategies for pharmacy benefit plans to manage rising prescription drug costs.
- To identify key plan design and benefit management techniques for cost containment and quality assurance.
Main Methods:
- Review of established pharmacy benefit management (PBM) strategies.
- Analysis of techniques including formulary management, intervention strategies, and cost-sharing mechanisms.
- Evaluation of mail-service pharmacy benefits for maintenance medications.
- Implementation of concurrent and retrospective review programs for compliance and practice pattern analysis.
Main Results:
- Formulary management, interventions, and cost-sharing effectively promote generic drug utilization.
- Mail-service pharmacies offer a cost-effective channel for maintenance medications.
- Review programs enhance plan compliance, identify prescribing trends, and guide appropriate drug selection.
Conclusions:
- Strategic implementation of PBM tools is crucial for controlling escalating drug costs.
- A multi-faceted approach combining formulary controls, mail-service options, and rigorous reviews optimizes cost-effectiveness and quality.
- Effective benefit design empowers plans to manage expenditures while ensuring member satisfaction and appropriate medication use.