When it comes to health care, there are two philosophies pushing against each other. But why does it get so heated?
One of the largest cost drivers is prescription drugs, and this is also the category with the largest increases
Healthcare providers and pharmacy benefit managers of today are keenly aware of specialty drugs. Managed care pharmacy plays a vital role today in medication administration and adherence. They are one way of managing chronic health conditions such as cancer, hemophilia, arthritis, HIV and others.
Optimizing pharmaceutical outcomes has become one of the fundamental issues for MCOs. Managed care pharmacy now plays a significant role in specialty medications. Therapies are most commonly injectable or IV products though some are formulated as oral medications.
Many specialty drugs are genetically engineered proteins derived from human genes, thus the term “bioIogics.”
Specialty drugs, according to Medicare, require uniquely appropriate handling and administration. The availability of specialty drugs is often limited and is generally supplied through selected distribution networks. This results in specialty drugs carrying a significant higher cost than that of non-specialty drugs.
The National Comprehensive Cancer Network made clear the responsibilities of specialty pharmacies. Specialty drugs are to be tracked according to policy standards. Patients stay in direct contact with health care providers to ensure that they keep well informed and follow proper protocol.
What Is Managed Care Pharmacy?
This health care management practice can be traced back in the 1930s. It is an organized health care delivery system specifically assigned to enhance the availability of health care. It’s also designed to extend excellent and comprehensive pharmaceutical care to a group of patients. It ensures overall improvement of healthcare and health conditions.
A managed care pharmacy coordinates directly with other health care providers to determine the most effective pharmaceutical treatment for patients. It focuses on the practice of administration. A managed care pharmacist identifies a specialty drug as either a medical or pharmacy benefit. He closely monitors the patient’s progress and consistently follows up on their condition. They also play an extremely important role in prior authorizations and tracking.
An important responsibility of the managed care pharmacy is to keep track of and account for the distribution of specialty drugs. This market makes up just 1% of the total patient population. Another role would be to monitor the patient’s compliance in administering specialty drugs. Ideally, this occurs in conjunction and coordination with the entire healthcare network and providers.
The Role of Managed Care Pharmacies in Specialty Drugs
As stated, specialty drugs are very expensive which creates the need and role of managed care pharmacy. Specialty pharmaceuticals will have a notable impact on pharmacy practice over the next decade and beyond. Efficient and effective medication management is now one of the top priorities of managed care pharmacy. The goal is to ensure the proper utilization of these high cost drugs.
Specialty drugs have unique modes of distribution and dispensing requirements compared to more traditional drugs. They require proper handling and storage and also monitoring of each patient. Distribution must follow the most appropriate channels for the very fact that they are specialty drugs.
The optimum role of managed care pharmacy is superior distribution of specialty drugs in the most cost effective manner.
Quality Healthcare Services
Delivering quality health care services should be the guiding principle of all health care contractors. Managed care pharmacies are best staffed with health care practitioners who offer the best assistance and advise possible. Managed care pharmacy ensures that patients receive the safest and most appropriate medication in a cost-effective fashion.
New medications to include specialty drugs are closely monitored for safety and effectiveness by managed care pharmacy professionals. Those professionals are composed of pharmacists, nurses, and physicians. They ensure that patients have full access to effective pharmaceuticals and are receiving the most appropriate therapies.
Relationship With Patients
When managed care pharmacy establishes good relationships with patients, essential medical care is established, This creates a positive impact on the patient’s life and thus benefits the entire community.
Pharmacists in a managed care pharmacy are acutely involved with diverse clinical services and a multitude of health care responsibilities. They would include proper distribution of medications, closely monitoring patient’s progress, therapy compliance and disease management. These needs are crucial, and demand that managed care pharmacy strives to offer cost-effective pharmaceutical care.
Managed care pharmacy isn’t necessarily always driven by financial strategy through new insurance products. The goal is to achieve patient satisfaction by offering support on comprehensive therapies and pharmaceutical services.
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Fee-for-service vs. value-based reimbursement is a somewhat controversial topic in health care at the moment. There have been tremendous reforms in