Health Care Rights? Scarcity Is the Controlling Factor 

With the American Health Care Act dominating the week’s news, one conversation has been unavoidable: Someone — someone who pays attention to public policy — will suggest that we pursue policy x, y, or z, and someone else — someone who pays a little less careful attention, who probably watches a lot of cable-television entertainment masquerading as news — responds: “The first thing we have to do is acknowledge that health care is a human right!” What follows is a moment during which the second speaker visibly luxuriates in his display of empathy and virtue, which is, of course, the point of the exercise. It’s kind of gross, but that’s where we are, politically, as a country. Here is a thought experiment: You have four children and three apples. You would like for everyone to have his own apple. You go to Congress, and you successfully persuade the House and the Senate to endorse a joint resolution declaring that everyone has a right to an apple of his own. A ticker-tape parade is held in your honor, and you share your story with Oprah, after which you are invited to address the United Nations, which passes the International Convention on the Rights of These Four Kids in Particular to an Individual Apple Each. You are visited by the souls of Mohandas Gandhi and Mother Teresa, who beam down approvingly from a joint Hindu-Catholic cloud in Heaven. Question: How many apples do you have? You have three apples, dummy. Three. You have four children. Each of those children has a congressionally endorsed, U.N.-approved, saint-ratified right to an apple of his own. But here’s the thing: You have three apples and four children. Nothing has changed. Declaring a right in a scarce good is meaningless. It is a rhetorical gesture without any application to the events and conundrums of the real world. If the Dalai Lama were to lead 10,000 bodhisattvas in meditation, and the subject of that meditation was the human right to health care, it would do less good for the cause of actually providing people with health care than the lowliest temp at Merck does before his second cup of coffee on any given Tuesday morning. Health care is physical, not metaphysical. It consists of goods, such as penicillin and heart stents, and services, such as oncological attention and radiological expertise. Even if we entirely eliminated money from the equation, conscripting doctors into service and nationalizing the pharmaceutical factories, the basic economic question would remain. We tend to retreat into cheap moralizing when the economic realities become uncomfortable for us. No matter the health-care model you choose — British-style public monopoly, Swiss-style subsidized insurance, pure market capitalism — you end up with rationing: Markets ration through prices, bureaucracies ration through politics. Price rationing is pretty straightforward: Think of Jesse James and his “Pay Up, Sucker!” tattoo on his palm. Political rationing is a little different: Sometimes it happens through waiting lists and the like, and sometimes it is just a question of money and clout. American progressives love the Western European medical model, but when Italian prime minister Silvio Berlusconi needed a pacemaker, he came to the United States to have it implanted. Rich people always get better stuff. That’s what it means to be rich. And money is only one resource: Political connections matter enormously in some places, as might a good family name or employment in a powerful firm. If you live in one of the poorer corners of the world, you may have “free” health care, meaning that if you should become infected with HIV, you will get a free aspirin. On the other hand, the Coca-Cola Company distributes antiretroviral drugs, free of charge, to employees around the world being treated for HIV. That may seem unfair to us. That may be unfair. It may be unfair that you have four kids and three apples. After we are done lamenting the unfairness of it all, what do we do? After we are done lamenting the unfairness of it all, what do we do? Ideally, we’d plant some apple trees. We would find ways to invest in medical care with an eye toward making it more effective and less expensive. There is no substitute for abundance. And the great enemy of abundance is the bias against profit. There is something deeply rooted in us that instinctively thinks we are being abused if someone else makes a profit on a deal. That is a dumb and primitive way of thinking — our world is full of wonders because it is profitable to invent them, build them, and sell them — but the angel is forever handcuffed to the ape. Ten years ago, I was in the office of a very fancy doctor who was always very pleased to see me, because I paid him out of pocket — my insurance card said “American Express” on it. If you can do this, I recommend it. The medical experience is very different when there is cash on the barrelhead: Appointments are kept, prices are known and negotiated beforehand, telephone calls are answe

Source: Health Care Rights? Scarcity Is the Controlling Factor | National Review

Specialty Drugs and the Role of Managed Care Pharmacy

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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.

Responsibility

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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Contact Steve at (682) 593-3430 or email steven.krohn@att.net