| Health plan approach to operationalizing a specialty drug management program. | |
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MedLine Citation:
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PMID: 18507510 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Expenditures related to specialty drugs consume a significant percentage of available health care resources. OBJECTIVE: Explain the process of transitioning the management of specialty drugs from medical services to pharmacy services in 2 managed care plans and provide insight into the issues encountered and solutions implemented based on 6 years of experience using traditional and innovative pharmacy utilization management tools to insure appropriate specialty drug use and reimbursement. SUMMARY: The level of involvement in a specialty management program varies from managing only products dispensed by the retail, mail, and specialty pharmacy vendor to encompassing a broad list of specialty drugs distributed through a variety of channels. Efficient administrative, operational, and clinical processes are critical to the success of the program. Additionally, an accurate and timely claims processing procedure is also essential for success as is the ability to mine data and effectively report on the use of specialty products. A clinically sound, cost-effective, and patient-friendly program requires input from health plan members, pharmacy service leaders, and physician providers, and must overcome challenges associated with disrupting current relationships and removing competing incentives. CONCLUSION: A well-constructed and properly funded specialty drug management program results in clinical and financial benefits for the plan. |
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Authors:
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Mesfin Tegenu |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of managed care pharmacy : JMCP Volume: 14 ISSN: 1083-4087 ISO Abbreviation: J Manag Care Pharm Publication Date: 2008 May |
Date Detail:
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Created Date: 2008-05-29 Completed Date: 2008-09-18 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9605854 Medline TA: J Manag Care Pharm Country: United States |
Other Details:
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Languages: eng Pagination: S17-21 Citation Subset: IM |
Affiliation:
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AmeriHealth Mercy/PerformRx, 200 Stevens Drive, 4th Floor, Pharmacy Services, Philadelphia, PA 19113, USA. mesfin.tegenu@performrx.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Drug Costs* Humans Insurance, Pharmaceutical Services / economics* Managed Care Programs / economics, organization & administration* Pharmaceutical Preparations / economics United States |
| Chemical | |
Reg. No./Substance:
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0/Pharmaceutical Preparations |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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