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Trends Driving Pharmacy Benefit Changes.

Top Line Research Report Issued by the Foundation for Managed Care Pharmacy

ALEXANDRIA, Va. -- A new study establishes a baseline for measuring emerging industry issues and trends that will define the managed care pharmacy environment of the future. Areas of focus encompass emerging electronic health information technologies, including e-prescribing; interoperability and integration issues at point-of-care in physician's offices and pharmacies; legal requirements for Medicare Part D medication therapy management services and programs; consumer-driven pharmacy benefit plan designs; pay-for-performance initiatives; formulary benefit design and other pharmacy management trends and practices.

The study was conducted among managed care pharmacy experts to determine what actions were being undertaken within large and small health plans and pharmacy benefit management (PBM) companies in these key areas. Cynthia J. Pigg, executive director of the Foundation, said, "Pharmacy is a highly utilized and valuable component of total health care and these emerging health care trends touch every aspect of the pharmacy benefit. However, no one has ever done a scientific survey to determine the impact of these trends from a managed care pharmacy perspective. We thought that undertaking such a survey now would provide a good snapshot of where we are today in the design and implementation of these developing trends, creating a yardstick that we can measure against in future years."

The study, entitled, "Benchmarking New Frontiers in Managed Care Pharmacy --Emerging Trends Research with Managed Pharmacy Experts," found that in spite of all the dialogue regarding electronic prescribing technologies, only about half the respondents had begun the process of designing or implementing such a program--but of those that had, over 20 percent were within a year of implementation. Among the largest organizations, about one-third had an operational system, and another 13 percent were nearly there.

Pigg stated, "In the pharmacy world, there currently exist so many systems for the transmission of pharmacy data, the outstanding issue seems to be interoperability more than system design. As a matter of fact, what we are sensing is that the initial use for such systems may be in disease and utilization management programs at the point of care, because electronic technologies readily lend themselves to performance measurement, while the assessment of quality is much more difficult." Most systems today reflect that finding, in that most were designed to facilitate billing, payment and record-keeping activities, rather than the creation or transmission of medical information.

"The study results showed," said Pigg, "that for elements of the Medicare Modernization Act such as pay for performance, medication therapy management and electronic medical records, tremendous opportunity exists for managed care pharmacy experts to get out in front and initiate action on the activities critical to quality patient care." The study also found that pharmacy benefit design in consumer driven health care (CDH) continues to be predominantly a standard tiered benefit system. More unique benefit designs to support CDH had been anticipated. However, another portion of the survey found newer CDH benefit designs are anticipated to emerge.

One surprising finding was the low percentage of respondents who evaluated total medical spend when measuring formulary compliance. Pigg says "What this tells us is that there is tremendous opportunity to enhance patient outcomes by managing pharmacy spend with the goal of reducing overall medical costs. For the good of the patient, pharmacy must be integrated into the broader health care discussion." The study was conducted by the HSM Group of Scottsdale, AZ. The study is available at:

The Foundation for Managed Care Pharmacy (FMCP) is a non-profit charitable trust recognized by the Internal Revenue Service as the educational and philanthropic arm of the Academy of Managed Care Pharmacy (AMCP). The Foundation supports the goals of and mission of AMCP and exists to advance the knowledge and insights of interested individuals and groups on major issues associated with the practice of pharmacy in a managed health care setting.
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Publication:Business Wire
Date:Feb 5, 2007
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