Managing the pharmacy benefit in Medicare HMOs: What do we really know?

An estimated five million Medicare beneficiaries received outpatient prescr iption drug benefits through Medicare+Choice in 1999. However, little is kn own about how these benefits are managed or about their effects on costs an d quality of care. This exploratory study applies a case-study methodology to four large Medicare health maintenance organizations (HMOs) to identify and assess drug-use management strategies. It also poses a number of import ant issues for consideration by both policymakers and health services resea rchers, as the debate rages on over the creation and administration of a Me dicare outpatient drug benefit, especially in light of the predilection for the use of private pharmacy benefit managers (PBMs) in many of these propo sals.