PBMs: DM programs are working, growing
Is it just a matter of semantics?
Phooey! That could be about the bluntest (and most printable) way to describe the reaction of some of the country’s largest pharmacy benefits managers (PBMs) those owned by drug companies to the gloom being cast on their future, especially in terms of disease management.
PCS Health Systems Inc. in Scottsdale, AZ, owned by Eli Lilly & Co., began offering its first six disease management programs in June 1996, and in recent months has added six more, currently offering disease management in acid peptic disorders, asthma, chronic obstructive pulmonary disorder, depression, diabetes, heart failure, hypertension, high cholesterol, infectious diseases, schizophrenia, and women’s and senior’s health, according to company officials.
PCS also began a mail service a year ago based in Forth Worth, TX, which can dispense about 30,000 prescriptions a day. Right now PCS’ scope covers 56 million people through about 54,000 pharmacies. "We have this foothold in the managed care pharmacy arena, and it made sense to look where we could meet the health care challenges of today with pharmacy-based disease management," says spokeswoman Bettylou Smith. "We have 1.5 billion pharmacy claims, and there is valuable information in that, and we have the right tools and people to extract information from that. We took the data under way and built a clinical division, which we view as across the whole continuum from prevention to treatment."
Diversified Pharmaceutical Services in Bloomington, MN, describes its disease management as "programs to provide information analysis and guidance to assist in management of asthma, coronary artery disease, depression, diabetes, osteoporosis, and ulcers," according to a statement provided to Drug Utilization Review. Diversified is owned by SmithKline Beecham.
Diversified says it already offers integrated pharmacy and medical data along with formulary management and claims processing for its 33 million "covered lives" (as of 1996) maintained by 52,000 pharmacists.
Merck-Medco, the third largest PBM-owned by a drug company, Merck & Co., has disease management programs that include diabetes, asthma, hypertension, and cholesterol care. Together these three companies control two-thirds of the PBM market. There are 76 PBMs nationwide.
Merck and PCS have released details of their respective diabetes programs to show how they are helping patients and saving money. Merck reports that of the 1,600 patients in its diabetes program, total health care savings came to $440 per patient per year when claims were compared before and after enrollment in the program. Merck reported that hospital admissions fell 21% overall (25% for diabetes-specific admissions), while outpatient visits fell 53%. The program stressed insulin management and compliance and reported that for patients who increased their use of insulin, comparable medical costs fell two or three times the previous rates.
PCS Health Systems says its diabetes program has saved $1,260 per patient per year. The program included direct educational efforts for patients at 11 regional health centers partnered with Control Diabetes Services. Patient education on compliance also was done by phone and mail. A one-year follow-up with patients found that hospital stays decreased by 72%, while emergency department visits fell by 71%.
Diversified declined to do an interview for this report, but in a written response to questions from DUR, the company said its future in traditional PBM services and in disease management is secure and growing.
[For more information, contact: Bettylou Smith, PCS Health Systems Inc., 9501 E. Shea Blvd., Scottsdale, AZ 85260. Telephone: (602) 391-4575. Mike Martin, Diversified Pharmaceutical Services, 7760 France Ave., Bloomington, MN 55344. Telephone: (610) 454-6091.]
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content