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Focusing on Pharmacoeconomics | NEWS-Line for Pharmacists
NEWSRoom | Source:  

Focusing on Pharmacoeconomics

Pharmacoeconomics - the study of the cost effectiveness of drugs - may offer a unifying outlook to pharmacists, pharmaceutical executives and health care providers concerned about health care reform.

Delegates from all areas of the pharmaceutical community in the Northeast and Mid-Atlantic states discussed the impact of pharmacoeconomics on the industry at the 15th Annual Northeast Pharmaceutical Conference, March 2-4, 1994, in Absecon, New Jersey.

Discussions centered upon the current state of the market, the challenges facing pharmacists, and the affect that the current economy and proposed healthcare reform will have on the future of the profession. Speakers included: William F. McGhan, Ph.D., Professor of Pharmacy at the Philadelphia College of Pharmacy and Science; Jean Paul Gagnon, Ph.D., Director of Pharmacoeconomic Applications at Marion Merrell Dow; Calvin J. Anthony, P.D., President NARD (National Association of Retail Druggists); Richard Levy, Ph.D., Vice President of the National Pharmaceutical Council and Edwin Webb, Pharm.D., Director of Government Affairs and Health Policy, American Association of Colleges of Pharmacy.

A Tough Market Will Force Change

Calvin J. Anthony discussed the changing environment for the practice of pharmacy. He stated that 50% of the elderly (16.6 million persons) lack coverage for pharmaceutical services, 4 million elderly have Medicare coverage with no other insurance. He noted that up to 21% of patients fail to have their prescription filled. Also, that of the 1.8 billion prescriptions filled each year, 50% are not taken properly. Most startling is the fact that 10% of all hospital admissions and 23% of nursing home admissions occur because of noncompliance with medical therapy and 57% of those (10%) could have been avoided by proper pharmaceutical care and counseling.

Recognizing these statistics, Dr. Anthony emphasized that pharmacy faces a once in a lifetime opportunity. Pharmacy is in a unique position as the most accessible health care provider, with emerging opportunities and new markets for cost effective pharmaceutical care. Pharmacists must focus upon improving the quality of life for patients, yet realize that managed care is more than managed cost. Pharmacists are concerned about reclaiming control of the profession, setting a priority of cost minimization and desirable quality patient outcomes.

Jean Paul Gagnon told the audience, "Drug buyers are asking the tough questions. A market place which once embraced new drugs is now asking 'What am I getting for what I am paying?' "

Gagnon mentioned that the response of pharmaceutical companies has been to conduct more pharmacoeconomic studies to demonstrate the value of drugs. "You're seeing this thing start to grow significantly."

The most profound impact of tight budgets for drug purchases may be a restructuring of the marketplace. "I see eventually five big integrated drug distribution alliances," Gagnon predicted. The alliances will be made up of drug companies, benefit managers, pharmacies and perhaps a wholesaler. "These alliances will then compete with each other and sell formularies on a capitated basis," Gagnon said.

The Challenge for Pharmacy

"Cost effectiveness analysis is really critical for the pharmacy profession and the pharmaceutical industry," William F. McGhan told attendees.

McGhan recommended that pharmacists focus attention on the issues surrounding security, simplicity, savings, quality, choice and evaluation of pharmaceutical care. It is essential for the pharmacist to be in a position to obtain reimbursement for cognitive services.

In addition to the basic elements of cost evaluation (cost minimization, cost benefit, cost utility and cost effectiveness), McGhan enumerated these additional cost issues of interest to pharmacists and the public:

~Cost per year of life saved
~Cost of illness
~Director costs of the illness and treatment
~Indirect costs
~Risk sharing

"There are numerous studies which show that pharmacists and pharmaceutical products are very cost effective.

We just have to continue to get that message across to decision makers," he said.

Edwin Webb discussed the costs of a professional pharmaceutical education as occupying a high priority for colleges of pharmacy. Most colleges are reviewing, and revising the professional curriculum. The revising process has reached the point where adding and deleting courses no longer satisfies the intention of keeping pace with developments in pharmacy and pharmaceutical care. Webb described the current Bachelor of Science in pharmacy curriculum as the most rigorous of any in the United States today. Faculties and the profession must find a means of obtaining public recognition for the enormous effort put forth by pharmacy students to prepare for their careers.

With teaching methods and outcomes changing, Webb stressed the importance of life long learning, especially the skills of communication, teaching and collaboration. "The goals of pharmaceutical education are moving from the dispensing of facts and skills to problem-solving, decision making and managing the process of safe and effective use of drugs to obtain optimum outcomes," stated Webb. "The heart of the pharmacists' management skills will be people, resources and outcome."

A Unifying Outlook

Since President Clinton's plan includes prescription drugs and recognizes the importance of quality care, NARD President Anthony was optimistic in his predictions for health care reform. "I fully believe it will be included in whatever program is passed," he said.

Echoing the theme of pharmacoeconomics, Anthony said, "We believe that one of the most cost-effective components in health care is quality pharmaceutical care. We will try to make our case that it is not only product, it's absolutely a necessity to provide that care if we really want to provide comprehensive health care."

"Cost effectiveness analysis is really critical for the pharmacy profession and the pharmaceutical industry," added William McGhan. "There are numerous studies which show that pharmacists and pharmaceutical products are very cost effective. We just have to continue to get that message across to decision makers," he said.

Richard Levy noted that attempts to control costs of individual components of the health care continuum will not demonstrate lasting effects on global costs. He described the evolving structural changes in the provision of health care as a paradigm shift in the minds of patients, payers and providers on the assumptions for delivery of health care from a focus upon institutional costs of treatment rather than considering the disease as the basic determinant of costs. He predicted increasing trends toward collaboration among providers in the future. Studies suggest that noncompliance with medication therapy reduces cost effectiveness of the pharmacoeconomic intervention.

In the discussing the outlook for the future, Dr. Gagnon called attention to the historical pattern of examining structure, process and outcomes. He pointed out that early on, the emphasis in pharmacy was placed upon structure, with some attention to process. Concern was expressed on the legal status of the provider, who may or may not follow accepted procedures for providing pharmaceutical services. Almost no attention was given to the issue of patient outcome. Evolving emphasis is on the issue of quality of life measures. Pharmacists must understand, evaluate and record measurable outcomes resulting from therapeutic intervention.

Further, Gagnon believes that pharmacists must band together to form coalitions for purchasing supplies and for negotiating with patient purchasing groups such as employers and insurers. He anticipates substantial vertical integration of pharmaceutical services. Most independent pharmacists must either start a group or join an existing group if they are to remain independent.

"It's time to network together," he said.

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