ECONOMIC-IMPACT OF COST-CONTAINMENT STRATEGIES IN 3RD-PARTY PROGRAMS IN THE UNITED-STATES .2.

This is the second article in a 2-part series that examines the econom ic impact of several different strategies used to control costs in thi rd party programmes. This article investigates 5 different methods: (a ) formularies; (b) capitation; (c) drug utilisation review; (d) prior approval; and (e) drug product selection. The published literature ind icates that use of formularies decreases drug expenditures, but these savings may be offset by expenditures in other areas of healthcare pro grammes. Capitation, though less well studied than other strategies, m ay show some effectiveness in reducing costs by increasing generic dis pensing and promoting switching from prescription drug to over-the-cou nter. Drug utilisation review, as a systematic programme of claims dat a review, has been shown to yield positive economic return in a variet y of areas, including both impersonal and face-to-face educational int erventions with healthcare practitioners. Prior approval and drug prod uct selection both result in savings when examined in isolation from o ther aspects of healthcare. Cost-shifting, administrative costs and co sts incurred because of possible decreased access to care have yet to be fully accounted for.