Evidence-based health benefits management: strategies to optimize antiretroviral medication adherence and outcomes in HIV/AIDS.
OBJECTIVE
To review how evidence-based principles can be applied to benefit design, specialty network management, and medication therapy management to successfully manage pharmaceutical benefits for patients infected with human immunodeficiency virus (HIV).


CONCLUSIONS
The most critical barrier to successfully managing HIV disease is suboptimal patient adherence to antiretroviral therapy. Managing HIV infection is unique in that the risk of treatment failure increases remarkably with even relatively minor lapses in patient adherence. The incremental cost of HIV treatment failure has been approximated at $26,000 per patient per year. Treatment failure, of course, also drives mortality related to HIV and acquired immunodeficiency syndrome (AIDS). Benefit design, specialty medication management strategies, and care management programs can be integrated to deliver high-quality, efficient care that optimizes clinical outcomes for populations of HIV-infected individuals.


CONCLUSIONS
Managed care programs can be structured to provide HIV care that allows optimal patient adherence and clinical outcomes.
Zabinski
Richard A
RA
UnitedHealthcare Corporation, 6300 Olson Memorial Hwy. MN010-E133, Golden Valley, MN 55427, USA. richard_a_zabinski@uhc.com
D023241:Antiretroviral Therapy, Highly Active; D019317:Evidence-Based Medicine; D006679:HIV Seropositivity / Q000188:drug therapy*; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D010593:Pharmaceutical Services / Q000458:organization & administration*; D014481:United States