MANAGED CARE PHARMACY, SOCIOECONOMIC ASSESSMENTS AND DRUG ADOPTION DECISIONS

A telephone survey of a representative national sample of 51 large man aged care organizations in the U.S. (> 50,000 enrollees) was undertake n (1) to understand the role of socioeconomic assessments on drug adop tion decisions; (2) to determine the sources of these assessments and the reliance of managed care pharmacy on each; and (3) to determine th e resources for internally versus externally performed drug assessment s. Socioeconomic assessments (clinical effectiveness, safety, cost of treatment. cost-effectiveness, and quality of life) are often tied to formulary decisions. Plans differ in their use of externally available socioeconomic assessments and in their ratings of the importance to d ecision making of drug assessments from the various sources. Those usi ng a specific source of drug assessment information rated them in the following order of importance: PBM assessments, other HMOs, peer revie wed literature, evaluations performed by industry, articles in non-pee r reviewed publications and, lastly, government reports. Timeliness an d comprehensiveness are important components of the overall utility of information. A high percentage of plans reported using some of the va rious types of assessments, with clinical effectiveness most common, a nd cost-effectiveness second. The percentage of new drugs that undergo assessments in each of the plans covers a broad range, with 57% of th e plans evaluating at least half of all new drugs. All but one surveye d managed care plan reported having either implemented or plans to imp lement a disease management program. Eighty percent of those surveyed are more concerned about drug assessments than in the past and 88% ant icipate greater future use. Although 38 plans (75%) have a person in t he organization responsible for drug assessments, this is the primary job in only 14 plans (37%). With greater reliance on drug assessments in the future, there are substantial opportunities for integrating dru g assessments, formularies and disease management programs. (C) 1997 E lsevier Science Ltd.