Pharmacy benefit management companies (PBMs) have evolved over the past decade in response to the increased demand for health care cost containment.
Their activities include the implementation of drug formularies and the negotiation of rebates from manufacturers.
Our analysis of this industry is based on interviews and materials provided by the top five ranked PBM companies which account for over 80% of beneficiaries covered within formulary plans.
The formularies of these companies are relatively inclusive, but they are becoming more restrictive over time.
At present the use of cost-effectiveness (C-E) studies in the formulary decisions of PBMs has been limited.
In this regard, the surveyed PBMs emphasized that most C-E studies have not compared therapeutic substitutes in populations with characteristics that are similar to those of their clients.
Pharmacy benefit management companies also have had strong incentives to focus narrowly on drug costs because they typically manage drug benefits on a « carved-out » basis.
However, PBMs anticipate a growing future role in the integrated management of patient care (disease management) for certain high cost chronic diseases and conditions.
All of the leading firms we surveyed have disease management programs in development.
The importance of C-E studies to PBM decisions is expected to increase significantly as disease management programs are implemented. (...)
Mots-clés Pascal : Industrie pharmaceutique, Bénéfice, Analyse coût efficacité, Prise décision, Prescription médicale, Stratégie, Economie santé, Etats Unis, Amérique du Nord, Amérique
Mots-clés Pascal anglais : Pharmaceutical industry, Profit, Cost efficiency analysis, Decision making, Medical prescription, Strategy, Health economy, United States, North America, America
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0432492
Code Inist : 002B30A01B. Création : 19/12/1997.