Concepts in Managed Care Pharmacy

Posted by Health Entrepreneur 11/30/2016

Managed care is not a new concept and in fact, has its roots dating back to the 1930s. The government first became involved in managed care in the year 1973 with the passage of Health Maintenance Organization Act. Managed care is today defined as an organized health care delivery system which is meant to improve the quality and accessibility of healthcare which includes pharmaceutical care and ensure containment of costs.

It is also hoped that managed care would improve outcomes and overall quality of life of the patient. In this article we look at the many aspects of managed care including the role in specialty pharmaceuticals.

Role of Managed Care in:

Disease Management:
Concept of reduction of health care costs and improvement in quality of life for individuals with chronic illness by prevention and minimization of disease through integration of care.
Electronic Prescribing:
E-Prescribing as it’s otherwise called, uses health care technology which can improve prescription accuracy, reduce costs, improve patient safety and secure, real-time, bi-directional, electronic connectivity between clinician
s and pharmacies.
Drug Utilization Review (DUR):
DUR is an authorized, structured and ongoing review of prescribing, dispensing and usage of medication.
Medication Errors:
Medication errors are among the most common medical errors, causing harm to at least 1.5 million people yearly (and one of the leading causes of death in the United States)
Medication Stockpiling (polypharmacy)
Polypharmacy can have major harmful effect on individual patients as well as entire populations. One of the areas covered under Managed care pharmacy would be medication stockpiling by streamlining medication refills and checking drug-drug interactions.

Maintaining Affordability
By securing drugs at lower prices from pharmaceutical manufacturers.
Patient Confidentiality
The US Congress passed the Health Insurance Portability and Accountability Act (HIPAA) in the year 1996. Managed care pharmacy plays a significant role in ensuring confidentiality.
Prior Authorization
A well-designed prior authorization program has to be implemented which will optimize patient outcomes by ensuring that patients get the most appropriate medications. This is sure to ensure reduction in waste, unnecessary prescription drugs and errors. 
Outcomes Research
This is a facet of research that will measure results of medical treatment and other intervention in patients to evaluate improvement in clinical outcomes
Specialty Pharmaceuticals
Over the last several years, cost and utilization of pharmacy products have risen exponentially creating an unsustainable system from the financial standpoint. This is how managed care could help…...

Managed care pharmacies and the role they would play in medication management over the next decade:
●    Speciality pharma will likely have a great impact on the practice of pharmacy in the next 10 years. 
●    This will affect all pharmacy practice settings and increase the need for medication management to ensure the appropriate use of important therapeutic agents.
●    In the treatment of chronic diseases such as diabetes, hypertension, asthma and others, the prevalent medication dispensing methods (retail pharmacy) would be replaced by mail order pharmacies.
●    Speciality pharmaceuticals which are meant for a smaller patient population (but higher utilization) would a different model for distribution, suggesting an ongoing evolution.
●    This model would require specified storage and handling, complex clinical management and close patient monitoring.
●    Today (as of 2016), 55% of the medicine distribution occurs in the setting of physician office while outpatient hospital and home infusion account for the rest. This would likely change with more of the dispensing moving to centralized pharmacies.    
●    Managed care pharmacy practice will push the speciality drug volume to specific providers who have a proven positive impact on the health outcomes, in an economical fashion.
●    In the next 10 years there will be the emergence of pharmacists who are based directly out of physician’s office and will provide the specialty medication to the patients.
●    Many of these medications would be dispensed right at patient bedside in the comfort of their homes.


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