Managed Care - June 2008 - (Page 50)

THE FORMULARY FILES Academic detailing effectively reduces Rx costs A review of studies conducted in managed care settings that used a variety of strategies to reduce prescription drug cost and improve the quality of medication use finds that the dissemination of education materials to physicians by itself has little or no effect on cost or quality. Researchers at Harvard Medical School and Harvard Pilgrim Health Care found that one-to-one academic detailing, computerized alerts and reminders, pharmacist-led collabo- “Formulary interventions rative care, and multifaceted disease management were effective. The can lead to discontinued review, in BMC Health Services Research, covered studies published from use of all drugs in the 2001 through 2007. affected class in some “One-to-one educational intervention has the potential to achieve the broad goal of increasing rational use of medicines and could deliver patients,” says Christine cost-effectiveness over the long term,” says Christine Lu, PhD, a Lu, PhD, Harvard Medical research fellow at Harvard Medical School and co-author of the study. School. She cautions that formulary interventions may be a quick fix for high drug spending but it could have negative outcomes because a member may avoid filling a prescription due to increased patient out-of-pocket expenses or formulary tier change. The studies were classified according to predominant strategy. The most common strategies were formulary-related interventions (40 percent), disease management (25 percent), monitoring and feedback (13 percent), educational interventions (12 percent), and collaborative care involving pharmacists (10 percent). Interventions targeting drug use Type of intervention Education All studies 20 Methodologically acceptable studies 7 Pre/post Randomized Interrupted studies with clinical trial time series comparison 5 0 2 Comments Dissemination of educational material is ineffective and one-to-one educational outreach visits are effective in increasing adherence to prescribing guidelines. Computerized alerts showed promise in improving short-term outcomes including changing prescribing and test ordering. Tiered formulary, patient copayment interventions, and prior authorizations decrease non-preferred drug use, reduce overall insurer costs, and increase patient out-pocket- expenses. Collaborative care led by pharmacists improves quality of care, including medication adherence Disease management interventions are associated with improvements in the process and quality of care, for both the short and long term. Monitoring and feedback 22 16 10 5 1 Formulary 66 15 2 5 8 Collaborative care involving pharmacists Disease management 15 5 3 0 2 41 8 7 0 1 Total 164 51 27 10 14 Source: Lu CY, Ross-Degnan D, Soumerai S, Pearson SA. Interventions designed to improve the quality and efficiency of medication use in managed care: A critical review of the literature — 2001–2007. BMC Health Serv Res. 2008;8:75–89. 50 MANAGED CARE / JUNE 2008

Table of Contents Feed for the Digital Edition of Managed Care - June 2008

Managed Care - June 2008 Editor’s Memo Contents Viewpoint Letters News and Commentary Legislation & Regulation Medication Management Compensation Monitor Plans Chart Course in Rough Waters A Conversation With Barbara Starfield, MD Smoke Signals from Payers Slow Going for Clinical Decision Support Back Pain and Physical Therapy Formulary Files PlanWatch Outlook

Managed Care - June 2008

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