Managing the pharmacy benefit in Medicare HMOs: what do we really know?
An estimated five million Medicare beneficiaries received outpatient prescription drug benefits through Medicare + Choice in 1999. However, little is known about how these benefits are managed or about their effects on costs and 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 important issues for consideration by both policymakers and health services researchers, as the debate rages on over the creation and administration of a Medicare outpatient drug benefit, especially in light of the predilection for the use of private pharmacy benefit managers (PBMs) in many of these proposals.
Lipton
H L
HL
Gross
D J
DJ
Stebbins
M R
MR
Syed
L H
LH
D000553:Ambulatory Care / Q000191:economics*; D003363:Cost Control; D016527:Drug Costs / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000191:economics*; D006270:Health Facility Administrators; D006279:Health Maintenance Organizations / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D007342:Insurance Benefits / Q000191:economics*; D006278:Medicare / Q000458:organization & administration*; D019982:Organizational Case Studies; D016134:Organizational Policy; D015397:Program Evaluation; D011787:Quality of Health Care; D020414:Risk Sharing, Financial / Q000458:organization & administration; D011795:Surveys and Questionnaires; D014481:United States