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AHRQ's Effective Health Care Program: its impact on managed care
1Pharmacy and Clinical Integrations, Humana, Inc., KY 40202, USA. wfleming@humana.com
Journal of Managed Care Pharmacy : JMCP
|March 24, 2007
Summary
Managed care organizations evaluate drug coverage based on safety, effectiveness, and cost. Stakeholders perceive treatment value differently, influencing healthcare decisions and potentially impacting future drug utilization.
Area of Science:
- Health economics
- Health services research
- Pharmacoeconomics
Background:
- The Agency for Healthcare Research and Quality (AHRQ) Effective Health Care Program, established by the Medicare Modernization Act of 2003, evaluates rheumatoid arthritis (RA) treatments in Medicare beneficiaries.
- Study findings may influence future drug utilization patterns, with potential applicability to the commercial population yet to be determined.
Purpose of the Study:
- To outline managed care perspectives on data development and coverage decisions for pharmaceuticals.
- To explore how different stakeholders perceive the value of medical treatments.
Main Methods:
- The study involves evaluating evidence on drug safety, effectiveness, outcomes, and cost.
- Analysis of how payers, such as managed care organizations and pharmacy benefit managers, make formulary and coverage decisions.
Main Results:
- Payers determine drug coverage and tier placement based on a comprehensive assessment of available evidence.
- Patient expectations of continuous treatment access contrast with payer assessments of value.
Conclusions:
- Stakeholder perceptions of treatment value vary, impacting healthcare decisions.
- The AHRQ Effective Health Care Program's findings will contribute to defining treatment value.
- Successful implementation of this program could significantly influence the healthcare landscape.
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