When a clinic run by pharmacy students implemented medication management with a closed formulary, it resulted in an average decrease in cost per prescription from $27 to $20. That was good news to the Sharing clinic, which serves the uninsured population of Omaha, Neb. Across the United States, approximately 59 student-run health clinics provide more than 36,000 student-provider clinic visits annually.

“The clinic was in jeopardy of closing, and a large part of its expenses was centered in its pharmacy budget,” says Kristen M. Cook, PharmD, an assistant professor of pharmacy at the University of Nebraska Medical Center.

There were three ways to deliver medications. First line delivery consisted of generic medications dispensed at the clinic and a bulk medication assistance program in which the clinic pharmacy contracted with a pharmaceutical company to provide in bulk the medications that were to be dispensed at the clinic.

The second delivery method was a medication assistance program that involved the dispensing of brand-name medications not available in generic form and of samples of branded drugs donated by pharmaceutical companies. The third line of delivery was reserved for contract pharmacy prescriptions, which were available at a designated contracted pharmacy.

During the two-year study, Cook says, 200 patients were treated, a majority for chronic conditions, including 62 percent for hypertension, 54 percent for diabetes, 46 percent for dyslipidemia, and 26 percent for depression. The average monthly cost to the clinic for medications decreased from $5,445 to $3,714. The study says that little or no cost for medications was shifted to patients.

Cook says the closed formulary was successful because of the physician buy-in up front. “They were involved in revising the formulary with us, looking at their own prescribing habits, and they had a lot of input as far as designing the formulary,” she says. What was most convincing? “We showed clinicians how much we were spending before implementing the formulary and afterward, and we showed them how much we could save per patient.”

Medication use, costs before and after formulary installed
  April 1, 2006 to March 31, 2007 April 1, 2007 to March 31, 2008
Total number of visits 941 696
Total number of prescriptions 4,284 3,423
Medication cost, mean ± SD $5,445±1,469 $3,714±847
Number of prescriptions, mean ± SD 356±44 285±40
Cost per patient, mean ± SD $33±52 $27±30
Cost per prescription, mean ± SD $27±42 $20±24
Estimated saving per prescription ($)
Bulk MAP 102 111
MAP 396 364
Bulk medication dispensed from clinic stock 8 10
Bulk MAP: bulk medication assistance program; MAP: medication assistance program

Source: Dvoracek JJ, Cook KM, Klepser DG. Student-run low-income family medicine clinic: Controlling costs while providing comprehensive medication management. J Am Pharm Assoc. 2010;50(3):384–387

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.