Pharmacy Management Issues Proliferate Along With the Drugs

John Marcille

I’ d love to tell you that we planned it this way, but it just happened. Many of the articles this issue deal with managing pharmaceuticals, with several focusing on specialty pharmacy. I pull a comparison from the shelf, one about publishing a newspaper before a presidential election: One topic overrides all others. There’s this difference, though: Elections end, but the challenges of medication use (and non-use) will always be with us. I think pharmacy might be more complex than politics, but that people in both fields share some of the same motives.

Our cover story came about because I found this interesting fact in the Express Scripts “2011 Drug Trend Report”: 37 percent of cancer patients on oral chemotherapies do not adhere. That shocked me. Nearly 40 percent of patients fighting an often life-threatening disease don’t take their medication? Managing Editor Frank Diamond’s report explains why, how such nonadherence leads to more costs down the road, and what one leading insurer has been doing about it.

Our supporting cast includes (in no particular order) stories about prior authorization for clinical, not cost, reasons, how providers at Memorial Sloan-Kettering said no to Zaltrap, how employers want a bigger role in managing specialty pharmacy, some new drug management techniques in general, tumor treating fields therapy, and how Geisinger Health Plan is handling the nonadherence problem for chronic disease.

Even the articles that don’t deal directly with drug management — such as the one about the Patient-Centered Outcomes Research Institute and the one about mental health parity and the old “carve in or carve out” choice — in their way touch on drug therapy.

Where does that leave us? With more threads to follow in the complex web of managed health care.