Pharmacist incentives continue upward trend
Annual survey tracks the state of the industry
The 1998 edition of the Novartis Pharmacy Benefit Report draws on the opinions of a variety of health care consumers, purchasers, and providers to determine how managed care administers pharmacy benefits and how much importance employees and other health care consumers attach to those benefits.
The Novartis report includes the results of surveys given to pharmacy and medical directors at health maintenance organizations (HMO) and pharmacy benefits management companies, employee benefit managers, managed Medicare and Medicaid programs, and consumers. It also provides an update on various trends, including state and federal legislation and disease management.
According to the report, consumers rank physician choice at the top of their list of "extremely important" factors in health plan offerings. That's followed by the availability of a prescription benefit, the reputation, and then the cost of a plan. The choice of a hospital rounds out the top five categories of importance.
Consumers also primarily seek out physicians (81.4%), then pharmacists (72.6%) for medication dosing and warning information, while 22.4% say they request generic equivalent drugs from a pharmacist.
Pharmacy directors surveyed say they are experiencing an expansion of pharmacy benefit reimbursement caps for commercial, group, and individual coverage.
Average dollar levels reported were between $2,000 and $3,000 a year for commercial/group members, and $500 to $1,000 for individuals. Pharmacy directors also say incentives continue to rise, primarily for drug withholds and/or risk pools and physician capitation. That jibes with HMO survey results, where 40% of HMOs expect to offer generic and preferred drug incentives in 1999.
HMOs target disease management
At the same time, HMOs and employers, 37.2% and 18.8% respectively, are predicting closed formularies to be in place by 1999, while 51.2% of HMO respondents and 56.3% of employers predict partially closed formulary designs by the end of the century.
Also from HMO surveys, 91.3% expect to offer mail service by next year, and 76% of HMO pharmacy directors say they are conducting disease management programs, with 81.6% targeting asthma, 78.9% diabetes, and 42.1% congestive heart failure.
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