Managed Care magazine

October 2009

Features

Cover Story

Large PBMs Transform Old Business Models
Urged on by employers, the Big 3 are going beyond traditional pharmacy benefit management, stressing consumer interactions and disease outcomes and threatening the existence of captive PBMs

Q&A

A Conversation with Richard ‘Buz’ Cooper, MD
Questioning the Reform Agenda

Docs and Insurers Work To Advance Health Literacy
Both AHIP and the AMA address ways to give better care to 75 million Americans who struggle to follow directions

Insurers Slow to Adopt Social Media Practices
Health plans weigh whether giving up control of the conversation with patients is worth all the possible benefits

Peer-Reviewed

Hypertension Epidemiology and Economic Burden: Refining Risk Assessment To Lower Costs

Departments

Editor’s Memo
PBMs, Medicare Advantage, Fraud Just Three Topics to Keep Track Of

Viewpoint
Medication Therapy Management — Not Just for Seniors Anymore
Employers know that managing chronic conditions and preventing drug-drug interactions can boost productivity

Legislation & Regulation
Medicare Advantage Can, Indeed, Be Superior
Well-run MA plans that stress care coordination present a winning formula, says study

Medication Management
Improved Adherence Highlights Specialty Pharmacy’s Potential
A great deal of money is at stake, to the tune of $1.7 trillion in 2030, according to the Pharmaceutical Care Management Association

Compensation Monitor
Majority of docs contract with managed care

Tomorrow’s Medicine
New Genomic Cancer Test Allows Better Decisions
Armed with a deeper understanding of tumor biology, insurers develop treatment algorithms to combat one of the most dreaded diseases

Managed Care Outlook
Middle class faces steeply rising premiums

News

Family Docs Outstrip Specialists in Prescribing Mental Health Drugs
PPO enrollment remains high, but location is a key factor

Oral Anticoagulation Patient Self-Testing: Consensus Guidelines For Practical Implementation

Warfarin’s narrow therapeutic range, variable biological effects, and potential for food and drug interactions present challenges in managing oral anticoagulation therapy with warfarin. Patient self-testing has been shown to result in significant benefits for patients and their families, health care practitioners, and health care systems.

Highlights:

Rationale for Wider Implementation of Patient Self-Testing
Patient Self-Testing Costs and Related Reimbursement
Practical Guidelines for Implementation of Patient Self-Testing
Summary of Consensus Panel Recommendations

Opioids in the Workplace

Advances in treatment have helped patients manage chronic pain with pharmaceutical pain relievers, but some drugs — particularly opioids — carry the risk of dependence. Opioid dependence is a medical condition, and it can be treated, but employers may not know about all the treatments that are now available, or that they are covered by most health plans.

Not only are treatments covered by insurance, but the Americans with Disabilities Act and the Drug Addiction Treatment Act, passed by Congress in 2000, encourage employers to support employees with opioid dependency. Qualifying physicians may now treat opioid dependence directly, letting the abuser seek help in the privacy of a physician’s office rather than at a public clinic.

Highlights

How opioids hijack the brain
Ways in which employers deal with dependence
Successful approaches to treatment