Pharmacy benefits management and ambulatory pharmacy services.

The business of pharmacy is changing dramatically as new components are added to our health care system and new terms developed to describe existing functions. For example, payment for pharmacy products and services are increasingly coming under control of Pharmacy Benefits Management (PBM) companies who are also racing to develop Disease State Management Programs. Additionally, health care purchasers have welcomed the development of HEDIS (Health Employer Data Information Set) as another tool to evaluate both the cost and quality of health care provided to their enrollees. All this means pharmacy will have to change its paradigm from dispensing to managing the medication consumption/compliance process in addition to traditional dispensing activities.

Contracting by managed care systems for pharmaceutical products and services.

The health care delivery system has received criticism because of its rapidly increasing costs. In an attempt to control costs, the administrators of managed care organizations are searching for cost control mechanisms. Thus, the administrators of managed care organizations appear to be searching carefully for any alternative method to lower the cost of delivering medical care to plan members. In this environment pharmacists must be extremely careful to study the cost of providing prescription services to managed care organizations, because they will be constrained by the obligations indicated in the contractual relationship. Any decisions to provide pharmaceutical services should be studied in detail after careful discussion with administrators of a managed care organization. Only after a careful analysis should a pharmacist make a decision to offer or not offer pharmaceutical services to a managed care organization.

Underutilization of antihypertensive drugs and associated hospitalization.

The association of underutilization of drugs prescribed for the treatment of hypertension and acute-care hospital readmissions was evaluated. The data base consisted of computerized hospitalization records and computerized out-patient pharmacy records, checked by chart audit for validity. The number of days' supply of antihypertensive agents was estimated by dividing the quantity of drugs dispensed by the daily dose indicated by the prescription instructions. All patients had been admitted to an acute-care hospital during a 6-month period with the diagnosis of hypertension. Following discharge from the hospital, drug utilization and readmission status were determined for a minimum of 1 year. The drug compliance of a group of patients who were readmitted to the hospital was compared with the patients who were not readmitted. The readmitted group had a significantly higher ratio of days when they were without any antihypertensive agents relative to the length of time in the study. There were no statistically significant differences in demographic features or blood-pressure levels between the patient groups. These findings indicate that underutilization of antihypertensive drugs may be associated with hospitalization, which could be prevented if patients had complied with their medication schedules.

Applied price competition in pharmacy practice.

This paper suggests that price as a marketing variable is often not given the attention it deserves. Price is influenced by such factors as managed health care and pharmacy's responses, such as PSAOs. It is proposed that PSAOs represent an important alternative to other economic delivery systems.

Effect of comprehensive pharmaceutical services on drug use in long-term care facilities.

The effect of comprehensive pharmaceutical services on drug consumption and cost in long-term care facilities was studied over an eight-year period. Medication administration records for 1970-1977 were obtained for all patients in three long-term care facilities served by a centralized pharmaceutical service. Services included unit dose drug delivery, drug use and chart review, and medical staff consultation. Data from a 10% sample of 4,004 patient records were analyzed. A significant (p less than 0.05) decline in the number of prescription drugs (42.8%) and the number of prescription doses (34.6%) consumed occurred over the eight-year period. The number of nonprescription drugs decreased significantly by 34.4%, but consumption of nonprescription drug doses was not changed significantly. When adjusted for inflation, the average monthly medication bill per patient decreased 28.9%, with the average for Medicaid patients being significantly (p less than 0.001) greater than that for private-pay patients. No significant changes occurred in the therapeutic categories of drug use. Centralized pharmaceutical services, pharmacist consultation and drug use review significantly reduced drug use and medication costs in the facilities studied.

Payment for nondistributive hospital pharmacy services--a regional survey.

Questionnaires were mailed to all (464) nongovernment, not-for-profit and investor owned for-profit hospital pharmacies in Washingon, Oregon and California. Responses were received from 350 institutions, a return rate of 75.4 percent. Pharmacists were asked to report data relating to the incidence of, the range of fees charged, and the extent of reimbursement received from third party carriers for the provision of nondistributive pharmacy services. The data received indicate that pharmacy consultation to physicians was provided by 77.9 percent of the respondents, drug therapy monitoring by 48.1 percent, generalized patient discharge consultation by 40.8 percent, CPR team participation by 27.2 percent, indepth patient discharge consultation by 17.5 percent and admitting medication history by 8.8 percent. Additionally, 12 institutions charged for providing 16 nondistributive pharmacy services. Directors of pharmacy from six hospitals indicated that they billed third party carriers for nondistributive pharmacy services as part of their total pharmacy charge via their usual billing procedure. All third party carriers billed in this manner paid for the nondistributive pharmacy service.

Pharmaceutical services in nongovernmental hospitals on the West Coast.

A survey of nongovernment, nonprofit and for-profit hospitals in Washington, Oregon and California was conducted to determine the incidence of selected hospital pharmacy services (1) directly related to drug distribution and (2) not directly related to drug distribution. Questionnaires were mailed to all qualifying hospitals in the three states; the return rate was 75.4%. Unit dose drug distribution was used in combination with other delivery systems by 58.3% of the respondents; 26.5% used unit dose exclusively. Over half of the respondents provided i.v. admixture programs, outpatient and inpatient discharge prescriptions, and inpatient medication profiles. Additionally, 77.9% provided pharmacy consultation to physicians. Nonprofit hospitals had significantly higher pharmacy staffing levels (both pharmacists and supportive personnel) than for-profit hospitals in the categories, "open seven days per week," "open nine to 16 hours per day," "open 17 to 24 hours per day, "101 to 200 beds" and "201 or more beds." Hospitals that provided the following services had significantly higher pharmacy staffing levels than those that did not provide the serices: unit dose drug distribution, i.v. admixture services, inpatient discharge prescriptions, inpatient medication profiles, drug therapy monitoring, and cardiopulmonary resuscitation team participation (difference of supportive staff only).