Summary
In the US, managed-care organisations (MCOs) have turned to pharmacy benefit management (PBM) companies to contain costs and provide total disease management packages. The demand for pharmacoeconomic research and information by purchasers of healthcare has contributed to the growth of PBM companies and to recent acquisitions by pharmaceutical manufacturers. PBMs influence prescribing via formulary management and drug utilisation review (DUR). Formularies are generally open, and pharmacoeconomic data contribute to formulary management decisions. Prospective and concurrent DURs used in hospitals can soon be integrated into community pharmacy, as PBMs obtain integrated online information about prescribing. PBM prescription databases are used as as educational tools for physicians, providing drug utilisation data, formulary compliance, generic prescribing rates, and guidelines for pharmacotherapy for particular conditions. They can also evaluate medication regimens for patients with particular problems such as drug-drug interactions. However, PBM databases typically lack patient diagnostic, outcome and medical claim data. PBMs will be better placed to move from medication management to disease management when they can obtain these data and link them appropriately to their own prescribing and physician databases.
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Thomas, N. The Role of Pharmacoeconomics in Disease Management. Pharmacoeconomics 9 (Suppl 1), 9–15 (1996). https://doi.org/10.2165/00019053-199600091-00004
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DOI: https://doi.org/10.2165/00019053-199600091-00004