Health plans' strategies for managing outpatient specialty pharmaceuticals.
Balancing increased spending for specialty pharmaceuticals while providing affordable and equitable coverage for consumers is a key issue for public and private payers. Health plans rely on an array of strategies, including both medical management and those used for more traditional pharmaceuticals. To explore specific management strategies for outpatient specialty pharmaceuticals, a survey was administered to thirty-eight Blue Cross and Blue Shield plans, focused on identifying core strategies. Prior authorization was the most commonly used strategy, implemented by 83.3 percent of respondents. Other frequently implemented management strategies included claims review (82.8 percent), formulary management (76.7 percent), and utilization review (70 percent).
Mullins
C Daniel
CD
Pharmaceutical Health Services Research Department at the University of Maryland School of Pharmacy in Baltimore, USA. dmullins@rx.umaryland.edu
Lavallee
Danielle Chauncey
DC
Pradel
Françoise G
FG
DeVries
Andrea R
AR
Caputo
Nadine
N
D000553:Ambulatory Care / Q000191:economics*; D054598:Blue Cross Blue Shield Insurance Plans / Q000458:organization & administration*; D017723:Drug Utilization Review; D005569:Formularies as Topic; D019538:Health Care Surveys; D006801:Humans; D007345:Insurance Claim Review; D007356:Insurance, Pharmaceutical Services; D014481:United States