Pharmacy Benefit Managers??? Role in Facilitating Medicare Beneficiary Access to Pharmaceutical Care

Disease Management and Medication Compliance

“…In a previously conducted survey of the disease management industry from the early 2000s, almost all respondents voiced confidence in the ability to achieve cost savings, and therefore assume risk in the form of capitated contracts. 33 In economic terms, 55% of disease managers describe their programs as cost-effective, 40% as cost saving, and 5% as having no effect on costs. There appears to be an inconsistency between the importance disease managers attribute to costeffectiveness and cost savings as selling points to potential contractors of programs targeting noncompliance (Fig.…”

“…Second, for disease management to demonstrate cost savings or cost-effectiveness of compliance programs, they must be able to identify avoidable adverse health outcomes, such as hospital admissions and emergency room visits, with adequate pharmacy and medical claims data at their disposal. 33 Therefore, a suggestion for evaluating the costsaving potential of a compliance program would be in terms of inpatient hospitalization days and emergency department visits, because these measures enable ''number needed to decrease'' analysis. 37 Further, ideally, to evaluate the costeffectiveness potential of a compliance program entails measurement of incremental cost-effectiveness, that is, comparing the costs and effectiveness of a compliance program to one that does not target compliance.…”