Pharmacy Benefit Management Institute Conference Highlights - Part 2

Medication Optimization in a New Healthcare Era

In medication use and improving patient outcomes, Susan Cooper, MPH, RPh, senior director, pharmacy services, HealthPartners, says her organization envisions prescription drug optimization going beyond addressing adherence. It seeks to improve the patient experience. Dr Cooper suggests that efficient optimization can underline the triple aim (quality, experience, and affordability) through successful integration approaches, including those that use technology.

Addressing underuse, overuse, and misuse of medications is important because nearly half of the current population do not currently adhere properly to medication. The reasons behind nonadherence vary—Dr Cooper says that it is easy to find thousands of studies that address the reasons, but “The bottom line is that there is no silver bullet or no 1 reason why people aren’t taking their medications.” Read more here.

A Comprehensive Medication Therapy Management (MTM) Program

James Gartner of CareSource and Patty Kumbera of OutcomesMTM shared the first-year results of a cooperative comprehensive medication therapy management (MTM) program that they implemented for nearly 1 million Ohio Medicaid members. As one of the country’s biggest Medicaid managed healthcare plans, CareSource provides consistency across MTM programs, including networking requirements, covered services policies and procedures, quality assurance, and documentation standards and reporting. OutcomesMTM leverages local relationships with pharmacists, patients, and prescribers while using innovative technology. Read more here.

Healthcare Industry Transformation to Meet Employer Demand for Managing Specialty Pharmacy Costs

According to Howard K. Crowley, head of pharmacy strategic initiatives, Aetna Pharmacy Management, a Towers Watson/ National Business Group on Health survey found that 29% of employers rank the rising costs of specialty drugs as a top challenge to keeping health benefit coverage affordable.

He says that while most prescriptions will be written for generic prescription drugs, most of the costs will be for specialty medication. In 2013 drug spending totaled $35 billion, but by 2021 is could be as high as $160 billion. He added that 77% of drug spend is associated with 6 therapeutic categories and 40% of drugs filed for FDA approval are specialty. Of course, specialty pharmacy costs are only part of the problem. Other challenges include the 90,000 projected shortfall of physicians by 2020, and the 46,000 projected shortfall of specialists by 2020. Read more here.