Showing outcomes and proving value brings success

Area of Science:

• Pharmacoeconomics
• Managed Care Pharmacy
• Health Outcomes Research

Background:

• The critical need for value assessment in formulary drug selection.
• Managed care organizations must ensure drugs provide demonstrable benefits beyond placebo.
• Regence BlueShield's commitment to outcome-based drug evaluation.

Purpose of the Study:

• To evaluate the effectiveness of Regence BlueShield's formulary submission guidelines.
• To determine if adopted guidelines ensure drugs offer superior outcomes compared to existing alternatives.
• To assess the impact of outcome-focused criteria in formulary management.

Main Methods:

• Implementation of formulary submission guidelines in 1998 by Regence BlueShield.
• Focus on clinical outcomes as a primary evaluation metric.
• Adoption of these guidelines by the Academy of Managed Care Pharmacy for nationwide evaluation.

Main Results:

• Regence BlueShield's guidelines proved to be a solid success.
• The guidelines ensure a focus on drugs that work better than established alternatives.
• The framework successfully shifted focus from placebo comparison to real-world efficacy.

Conclusions:

• Outcome-based evaluation is critical for pharmacoeconomic value.
• Regence BlueShield's formulary guidelines represent a successful model for managed care.
• The nationwide adoption by AMCP signifies the importance and effectiveness of this approach.