Managed Markets Summit Highlights Part 1

How Clinical Evidence Drives Formulary Decision-Making

Laurie Wesolowicz, PharmD, director, pharmacy services clinical, Blue Cross Blue Shield of Michigan (BCBSM), says that clinical evidence and other factors can drive formulary decision-making. Evidence can influence the value and coverage recommendations for drugs covered under the pharmacy (formulary) and medical benefits.

In particular, she addresses BCBSM’s formulary decision-making structure, which includes the BCBSM/Blue Care Network (BCN) Pharmacy and Therapeutics Committee. The Committee is comprised of a Clinical Core Workgroup, Blue Cross Blue Shield, BCN HMO, BCBSM Medicare Part D, a Specialty Drug Workgroup, and BCN Medicare Part D.

Dr Wesolowicz also suggests that comparative effectiveness research can influence the overall assessment of a given drug’s safety and quality for formulary and coverage decisions. She adds that there is a growing focus on evidence-based decision-making, especially in administration of high-cost specialty drugs. Read the full story here: http://bit.ly/1llrVqr

Health Information Technology and the Road to Reform

Health information technology (HIT) was the focus of a discussion led by Farzad Mostashari, MD, visiting fellow, Brookings Institution, former national coordinator for HIT, US Department of Health and Human Services. In his Managed Markets Summit 2014 keynote address, “Health IT and Reform: The Road to Right Care,” Dr Mostashari touched upon the obstacles and shortcomings in our nation's healthcare landscape, and asserted that more prominent usage of HIT would help to alleviate fiscal concerns and affect better outcomes in patient care. By examining what has been done thus far in terms of HIT, Dr Mostashari substantiated his call for multifaceted reform.

When it comes to healthcare, as Dr Mostashari put it, you get what you pay for. “So, what do we get?” We get lots of heads and beds,” he added. The message was clear: we need new payment models in healthcare. Read the full story here: http://bit.ly/1mB6lfF

Continuing conference coverage and exclusive interviews from The Managed Markets Summit are available here: http://www.ajmc.com/conferences/mms2014