scholarly journals Data for drugs available through low-cost prescription drug programs are available through pharmacy benefit manager and claims data

2012 ◽  
Vol 12 (1) ◽  
Author(s):  
Vivienne J Zhu ◽  
Anne Belsito ◽  
Wanzhu Tu ◽  
J Marc Overhage
Keyword(s):  
Prescription Drug ◽  
Claims Data ◽  
Low Cost ◽  
Pharmacy Benefit Manager ◽  
Pharmacy Benefit

scholarly journals Common Agent or Double Agent? Pharmacy Benefit Managers in the Prescription Drug Market

2021 ◽  
Author(s):  
Rena Conti ◽  
Brigham Frandsen ◽  
Michael Powell ◽  
James Rebitzer
Keyword(s):  
Prescription Drug ◽  
Drug Market ◽  
Pharmacy Benefit ◽  
Double Agent ◽  
Prescription Drug Market

scholarly journals Impact of Pharmacy Benefit Managers on Oncology Practices and Patients

2020 ◽  
Vol 16 (5) ◽  
pp. 276-284 ◽  
Author(s):  
Trevor J. Royce ◽  
Caroline Schenkel ◽  
Kelsey Kirkwood ◽  
Laura Levit ◽  
Kathryn Levit ◽  
...  
Keyword(s):  
Prescription Drug ◽  
Prescription Drugs ◽  
Business Practices ◽  
Pharmacy Benefit ◽  
Drug Benefits ◽  
Quality Cancer Care ◽  
Number Of Patients ◽  
Oncology Care ◽  
The Impact

Pharmacy benefit managers (PBMs) are thoroughly integrated into the drug supply chain as administrators of prescription drug benefits for private insurers, self-insuring business, and government health plans. As the role of PBMs has expanded, their opaque business practices and impact on drug prices have come under increasing scrutiny. PBMs are particularly influential in oncology care because prescription drugs play a major role in the treatment of most cancers and an increasing number of patients with cancer are treated with oral oncology agents managed by PBMs. There is concern that some PBM practices may threaten access to high-quality cancer care and may increase the financial and administrative burden on patients and practices. In this article, we review the role of PBMs in prescription drug coverage and reimbursement, discuss the impact of PBMs on oncology care, and present data from the 2018 ASCO Practice Survey assessing the knowledge and attitude of oncology practices toward PBMs.

scholarly journals Adverse Selection and the Challenges to Stand-Alone Prescription Drug Insurance

2004 ◽  
Vol 7 (1) ◽  
Author(s):  
Mark V. Pauly ◽  
Yuhui Zeng
Keyword(s):  
Prescription Drug ◽  
Adverse Selection ◽  
Claims Data ◽  
Insurance Markets ◽  
Drug Insurance ◽  
Medical Expenses ◽  
Death Spiral ◽  
Prescription Drug Insurance ◽  
Intuitive Model ◽  
Outpatient Drug

This paper investigates a possible predictor of adverse selection problems in unsubsidized stand-alone prescription drug insurance: the persistence of an individual’s high spending over multiple years. Using Medstat claims data and data from the Medicare Survey of Current Beneficiaries, we find that persistence is much higher for outpatient drug expenses than for other categories of medical expenses. We then use these estimates to develop a simple and intuitive model of adverse selection in competitive insurance markets and show that this high relative persistence makes it unlikely that unsubsidized drug insurance can be offered for sale, even with premiums partially risk adjusted, without a probable adverse selection death spiral. We show that this outcome can be avoided if drug coverage is bundled with other coverage, and we briefly discuss the need either for comprehensive coverage or generous subsidies if adverse selection is to be avoided in private and Medicare insurance markets.

scholarly journals Universal Patient Identifier and Interoperability for Detection of Serious Drug Interactions: Retrospective Study

10.2196/23353 ◽  
2020 ◽  
Vol 8 (11) ◽  
pp. e23353
Author(s):  
Howard Michael Sragow ◽  
Eileen Bidell ◽  
Douglas Mager ◽  
Shaun Grannis
Keyword(s):  
United States ◽  
Drug Interaction ◽  
Drug Interactions ◽  
The United States ◽  
Security And Privacy ◽  
Patient Identification ◽  
Pharmacy Benefit Manager ◽  
Pharmacy Benefit ◽  
Privacy Concerns ◽  
Drug Drug Interaction

Background The United States, unlike other high-income countries, currently has no national unique patient identifier to facilitate health information exchange. Because of security and privacy concerns, Congress, in 1998, prevented the government from promulgating a unique patient identifier. The Health and Human Services funding bill that was enacted in 2019 requires that Health and Human Services report their recommendations on patient identification to Congress. While there are anecdotes of incomplete health care data due to patient misidentification, to date there have been insufficient large-scale analyses measuring improvements to patient care that a unique patient identifier might provide. This lack of measurement has made it difficult for policymakers to balance security and privacy concerns against the value of potential improvements. Objective We sought to determine the frequency of serious drug-drug interaction alerts discovered because a pharmacy benefits manager uses a universal patient identifier and estimate undiscovered serious drug-drug interactions because pharmacy benefit managers do not yet fully share patient records. Methods We conducted a retrospective study of serious drug-drug interaction alerts provided from September 1, 2016 to August 31, 2019 to retail pharmacies by a national pharmacy benefit manager that uses a unique patient identifier. We compared each alert to the contributing prescription and determined whether the unique patient identifier was necessary in order to identify the crossover alert. We classified each alert’s disposition as override, abandonment, or replacement. Using the crossover alert rate and sample population size, we inferred a rate of missing serious drug-drug interaction alerts for the United States. We performed logistic regression in order to identify factors correlated with crossover and alert outcomes. Results Among a population of 49.7 million patients, 242,646 serious drug-drug interaction alerts occurred in 3 years. Of these, 2388 (1.0%) crossed insurance and were discovered because the pharmacy benefit manager used a unique patient identifier. We estimate that up to 10% of serious drug-drug alerts in the United States go undetected by pharmacy benefit managers because of unexchanged information or pharmacy benefit managers that do not use a unique patient identifier. These information gaps may contribute, annually, to up to 6000 patients in the United States receiving a contraindicated medication. Conclusions Comprehensive patient identification across disparate data sources can help protect patients from serious drug-drug interactions. To better safeguard patients, providers should (1) adopt a comprehensive patient identification strategy and (2) share patient prescription history to improve clinical decision support.

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