Pub Date : 2015-09-15DOI: 10.18553/JMCP.2001.7.4.272
S. Sullivan, A. Lyles, B. Luce, Joseph Grigar
This paper reports on the Academy of Managed Care Pharmacy's (AMCP's) suggested process for pharmaceutical manufacturers to submit a uniform, evidence-based dossier for each product submitted for formulary approval. The process requires that manufacturers provide clinical and economic evidence and an economic model that projects the potential economic consequences and impact of product coverage on health outcomes. This formulary-submission process is designed to achieve two main goals: (1) improve the timeliness, scope, quality, and relevance of information provided to pharmacy and therapeutics (PT and (2) streamline the process of acquiring data and reviewing products for health plan staff pharmacists. In time, it is hoped; this process will lead to progressive improvements in the quality of formulary submissions and provide P&T committees with evidence that previously was often unavailable.
{"title":"AMCP Guidance for Submission of Clinical and Economic Evaluation Data to Support Formulary Listing in U.S. Health Plans and Pharmacy Benefits Management Organizations","authors":"S. Sullivan, A. Lyles, B. Luce, Joseph Grigar","doi":"10.18553/JMCP.2001.7.4.272","DOIUrl":"https://doi.org/10.18553/JMCP.2001.7.4.272","url":null,"abstract":"This paper reports on the Academy of Managed Care Pharmacy's (AMCP's) suggested process for pharmaceutical manufacturers to submit a uniform, evidence-based dossier for each product submitted for formulary approval. The process requires that manufacturers provide clinical and economic evidence and an economic model that projects the potential economic consequences and impact of product coverage on health outcomes. This formulary-submission process is designed to achieve two main goals: (1) improve the timeliness, scope, quality, and relevance of information provided to pharmacy and therapeutics (PT and (2) streamline the process of acquiring data and reviewing products for health plan staff pharmacists. In time, it is hoped; this process will lead to progressive improvements in the quality of formulary submissions and provide P&T committees with evidence that previously was often unavailable.","PeriodicalId":50156,"journal":{"name":"Journal of Managed Care Pharmacy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.18553/JMCP.2001.7.4.272","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67490062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-15DOI: 10.18553/JMCP.2001.7.5.414
M. Ferrill
Over the past ten years, natural products have become quite popular in the United States; about 60% of Americans use natural products daily. Herbs and other botanicals, vitamins, minerals, amino acids, and other natural products are sold as dietary supplements in the United States rather than as over-the-counter (OTC) or prescription products. Because they are sold and marketed as dietary supplements, they are not held to the same level of rigorous preapproval testing for safety and efficacy as pharmaceutical products. Although many of these products can be beneficial and there are few reported problems, the potential for serious health problems does exist. These potential problems can be due to allergic reactions, interactions between natural products, interactions between natural products and OTC or prescription medications, interactions between natural products and disease states, or even poor quality or contamination of the product. Because the potential for serious problems is real, as recently addressed by the Department of Health and Human Services, Office of the Inspector General, issues and information on managing natural products in a managed care environment are presented here. The goal of this continuing education program is to present information, options, and resources to help pharmacists in managed care settings manage the use of natural products in their patient populations.
{"title":"Managing Natural Products","authors":"M. Ferrill","doi":"10.18553/JMCP.2001.7.5.414","DOIUrl":"https://doi.org/10.18553/JMCP.2001.7.5.414","url":null,"abstract":"Over the past ten years, natural products have become quite popular in the United States; about 60% of Americans use natural products daily. Herbs and other botanicals, vitamins, minerals, amino acids, and other natural products are sold as dietary supplements in the United States rather than as over-the-counter (OTC) or prescription products. Because they are sold and marketed as dietary supplements, they are not held to the same level of rigorous preapproval testing for safety and efficacy as pharmaceutical products. Although many of these products can be beneficial and there are few reported problems, the potential for serious health problems does exist. These potential problems can be due to allergic reactions, interactions between natural products, interactions between natural products and OTC or prescription medications, interactions between natural products and disease states, or even poor quality or contamination of the product. Because the potential for serious problems is real, as recently addressed by the Department of Health and Human Services, Office of the Inspector General, issues and information on managing natural products in a managed care environment are presented here. The goal of this continuing education program is to present information, options, and resources to help pharmacists in managed care settings manage the use of natural products in their patient populations.","PeriodicalId":50156,"journal":{"name":"Journal of Managed Care Pharmacy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67490267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-15DOI: 10.18553/JMCP.1995.1.2.80
M. Gore
{"title":"Professional Opportunities in Managed Care","authors":"M. Gore","doi":"10.18553/JMCP.1995.1.2.80","DOIUrl":"https://doi.org/10.18553/JMCP.1995.1.2.80","url":null,"abstract":"","PeriodicalId":50156,"journal":{"name":"Journal of Managed Care Pharmacy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68347830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-15DOI: 10.18553/JMCP.1997.3.2.125
E. Zablocki
{"title":"Looking Back, Glancing Ahead: State and Federal Legislative Fronts","authors":"E. Zablocki","doi":"10.18553/JMCP.1997.3.2.125","DOIUrl":"https://doi.org/10.18553/JMCP.1997.3.2.125","url":null,"abstract":"","PeriodicalId":50156,"journal":{"name":"Journal of Managed Care Pharmacy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68350154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-15DOI: 10.18553/JMCP.1997.3.4.415
Larry Barenbaum
dened a rather poor government in its attempt to resurrect some sort of systematic structure from the previous dominance of Soviet health care. AMCP board member Larry Barenbaum was hired by. BHM Consulting to review the technical assistance provided by an American agency aiding the Kazakhstan Ministry of Health in its monumental move toward privatization. At the 1993 Vancouver Summit by President Bill Clinton and Russian President Boris Yeltsin, the u.s. agreed to send professional and
{"title":"Pharmaceutical Privatization and Reform Program in Kazakhstan","authors":"Larry Barenbaum","doi":"10.18553/JMCP.1997.3.4.415","DOIUrl":"https://doi.org/10.18553/JMCP.1997.3.4.415","url":null,"abstract":"dened a rather poor government in its attempt to resurrect some sort of systematic structure from the previous dominance of Soviet health care. AMCP board member Larry Barenbaum was hired by. BHM Consulting to review the technical assistance provided by an American agency aiding the Kazakhstan Ministry of Health in its monumental move toward privatization. At the 1993 Vancouver Summit by President Bill Clinton and Russian President Boris Yeltsin, the u.s. agreed to send professional and","PeriodicalId":50156,"journal":{"name":"Journal of Managed Care Pharmacy","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68351232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-15DOI: 10.18553/JMCP.1997.3.5.511
M. Indritz
{"title":"Examining the Managed Health Care Continuum","authors":"M. Indritz","doi":"10.18553/JMCP.1997.3.5.511","DOIUrl":"https://doi.org/10.18553/JMCP.1997.3.5.511","url":null,"abstract":"","PeriodicalId":50156,"journal":{"name":"Journal of Managed Care Pharmacy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.18553/JMCP.1997.3.5.511","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68351674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-15DOI: 10.18553/jmcp.1997.3.4.425
C. Mullins
OBJECTIVE: To determine the marginal effect of including a minor, yet common, gastrointestinal (GI) side effect in a cost effectiveness analysis of NSAID therapy. DESIGN: Base economic model of cost effectiveness analysis (CEA) developed using data from a randomized controlled trial of two formulations of an NSAID therapy (conventional versus extended release etodolac) for the treatment of osteoarthritis (OA) of the knee. SETTING: Outpatient. PARTICIPANTS: 225 patients with osteoarthritis of the knee. INTERVENTIONS: Patients were randomized to receive either conventional or extended release etodolac with primary endpoints evaluated at four weeks. Cost effectiveness was calculated from a managed care perspective as dollars spent per OA patient treated, focusing on the marginal dollar value of reduced side effects. Costs included in the analysis were initial ($64 or $71) and subsequent ($64) prescriptions for NSAID therapy, pharmacological treatment of side effects ($79) and physician office visits ($50). M...
{"title":"Pharmacoeconomics of NSAIDs: Beyond Bleeds","authors":"C. Mullins","doi":"10.18553/jmcp.1997.3.4.425","DOIUrl":"https://doi.org/10.18553/jmcp.1997.3.4.425","url":null,"abstract":"OBJECTIVE: To determine the marginal effect of including a minor, yet common, gastrointestinal (GI) side effect in a cost effectiveness analysis of NSAID therapy. DESIGN: Base economic model of cost effectiveness analysis (CEA) developed using data from a randomized controlled trial of two formulations of an NSAID therapy (conventional versus extended release etodolac) for the treatment of osteoarthritis (OA) of the knee. SETTING: Outpatient. PARTICIPANTS: 225 patients with osteoarthritis of the knee. INTERVENTIONS: Patients were randomized to receive either conventional or extended release etodolac with primary endpoints evaluated at four weeks. Cost effectiveness was calculated from a managed care perspective as dollars spent per OA patient treated, focusing on the marginal dollar value of reduced side effects. Costs included in the analysis were initial ($64 or $71) and subsequent ($64) prescriptions for NSAID therapy, pharmacological treatment of side effects ($79) and physician office visits ($50). M...","PeriodicalId":50156,"journal":{"name":"Journal of Managed Care Pharmacy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68351699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-15DOI: 10.18553/jmcp.1997.3.5.494
L. Epstein
{"title":"The Changing Face of Managed Care Pharmacy and the Role of PBMs","authors":"L. Epstein","doi":"10.18553/jmcp.1997.3.5.494","DOIUrl":"https://doi.org/10.18553/jmcp.1997.3.5.494","url":null,"abstract":"","PeriodicalId":50156,"journal":{"name":"Journal of Managed Care Pharmacy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68352016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-15DOI: 10.18553/JMCP.1997.3.6.691
B. Else
OBJECTIVE: To estimate the likelihood of the use of glycosylated hemoglobin testing (HbA1c) among a cohort of patients with diabetes mellitus in a managed care setting. DESIGN: A retrospective, cross-sectional analysis of managed care claims data obtained from the private business claims (PSC) files of the Hawaii Medical Service Association for the calendar year 1995. A probit model was used to estimate the probability of the dependent variable (HbA1c). Independent variables specified in the model included age, gender, presence of common comorbidities, use of insulin and oral anti-diabetic agents, and type of insurance plan. The probit model was run for an n of 6,841 patients. SETTING: Health insurer in the state of Hawaii. Includes managed care and indemnity products. PATIENTS: 6,841 patients under 65 years old were identified by paid claims with ICD-9-CM codes of 250.xx. PARTICIPANTS: Not applicable. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Use of HbA1c testing. RESULTS: Age and gender are n...
{"title":"Use of Glycosylated Hemoglobin Testing Among Patients with Diabetes Mellitus","authors":"B. Else","doi":"10.18553/JMCP.1997.3.6.691","DOIUrl":"https://doi.org/10.18553/JMCP.1997.3.6.691","url":null,"abstract":"OBJECTIVE: To estimate the likelihood of the use of glycosylated hemoglobin testing (HbA1c) among a cohort of patients with diabetes mellitus in a managed care setting. DESIGN: A retrospective, cross-sectional analysis of managed care claims data obtained from the private business claims (PSC) files of the Hawaii Medical Service Association for the calendar year 1995. A probit model was used to estimate the probability of the dependent variable (HbA1c). Independent variables specified in the model included age, gender, presence of common comorbidities, use of insulin and oral anti-diabetic agents, and type of insurance plan. The probit model was run for an n of 6,841 patients. SETTING: Health insurer in the state of Hawaii. Includes managed care and indemnity products. PATIENTS: 6,841 patients under 65 years old were identified by paid claims with ICD-9-CM codes of 250.xx. PARTICIPANTS: Not applicable. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Use of HbA1c testing. RESULTS: Age and gender are n...","PeriodicalId":50156,"journal":{"name":"Journal of Managed Care Pharmacy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68352387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-15DOI: 10.18553/JMCP.1997.3.6.699
Charles R. Phillips
OBJECTIVE: To present a managerial approach for evaluating the performance of a drug prior authorization (PA) program, illustrated through an evaluation of the Iowa Medicaid drug PA program. DESIGN: A before-and-after comparison without a control group. SETTING: State of Iowa Medicaid Program. PATIENTS: Iowa Medicaid enrollees (approximately 250,000). INTERVENTION: Medicaid Drug Prior Authorization (PA) Program. MAIN OUTCOME MEASURES: Operational and economic performance, including volume of prior authorization requests, PA program response times, PA approval rates by therapeutic category, medication utilization, and PA program savings and administrative costs. RESULTS: Overall, 82.9% of new and extension PA requests were approved for coverage. Of the new PA requests, 74.4% were approved for coverage, while 92.5% of PA extensions were approved. The average response time for new requests and extensions was 52.4 (s.d.=1 01.8) minutes. New PA responses averaged 73.2 (s.d.=119.6) minutes, while extensions ave...
{"title":"Evaluating the Operational Performance and Financial Effects of a Drug Prior Authorization Program","authors":"Charles R. Phillips","doi":"10.18553/JMCP.1997.3.6.699","DOIUrl":"https://doi.org/10.18553/JMCP.1997.3.6.699","url":null,"abstract":"OBJECTIVE: To present a managerial approach for evaluating the performance of a drug prior authorization (PA) program, illustrated through an evaluation of the Iowa Medicaid drug PA program. DESIGN: A before-and-after comparison without a control group. SETTING: State of Iowa Medicaid Program. PATIENTS: Iowa Medicaid enrollees (approximately 250,000). INTERVENTION: Medicaid Drug Prior Authorization (PA) Program. MAIN OUTCOME MEASURES: Operational and economic performance, including volume of prior authorization requests, PA program response times, PA approval rates by therapeutic category, medication utilization, and PA program savings and administrative costs. RESULTS: Overall, 82.9% of new and extension PA requests were approved for coverage. Of the new PA requests, 74.4% were approved for coverage, while 92.5% of PA extensions were approved. The average response time for new requests and extensions was 52.4 (s.d.=1 01.8) minutes. New PA responses averaged 73.2 (s.d.=119.6) minutes, while extensions ave...","PeriodicalId":50156,"journal":{"name":"Journal of Managed Care Pharmacy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68352495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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