Strong evidence demonstrates the effectiveness of several managed care pharmacy tools for achieving intended outcomes, such as increased utilization of preferred drugs, formulary compliance, and decreased prescription drug spending, according to an Academy of Managed Care Pharmacy (AMCP)-sponsored literature review.
The review, conducted by Abt Associates, Cambridge, Massachusetts, examined six managed care pharmacy interventions:
- Step therapy (7 studies)
- Prior authorization review (9 studies)
- Therapeutic interchange (5 studies)
- Tiered formularies (27 studies)
- Drug utilization review (4 studies)
- Medication therapy management (11 studies).
Tiered formularies were found to decrease drug utilization of nonpreferred drugs, encourage formulary compliance among patients, and reduce prescription drug spending. The findings regarding patient out-of-pocket expenditures, however, were mixed.
Prior authorization review was found to reduce utilization of and expenditures on nonpreferred drugs. Again, the findings were mixed with regard to patient outcomes, specifically discontinuation rates.
Step therapy, though lowering prescription costs for payers, was found to be associated with decreased continuation rates and increased discontinuation rates. The paucity of research on this subject highlights the need to further examine the effect of step therapy on utilization, costs, and clinical and humanistic outcomes.
The use of therapeutic interchange has declined with the success of tiered benefits and step therapy. In the review, the intervention was found to have mixed results, with some patients switching back to nonpreferred drugs.
Drug utilization review also has a paucity of research to determine its true effects on the discontinuation rates for the target drug(s).
Medication therapy management was found to improve several clinical measures, including blood pressure, cholesterol levels, and hypertension. The effect of this intervention on the number of medications and medication costs was found to be mixed.
The AMCP noted some limitations to the report, such as the search being restricted to research conducted within managed care organizations and the literature not representing the full array of research in managed care pharmacy. The AMCP encourages managed care organizations to publish studies based on analyses of existing data and to conduct research in managed care pharmacy intervention that is focused on patient outcomes.