With Study Finding 30 Percent of Medicare Hospital Spending on Chronically Ill Unnecessary, PCMA Urges Policymakers to Resist Efforts to Erode Proven Pharmacy Management Tools

(Washington, DC)—A new report from the Dartmouth Atlas Project finds that as much as 30 percent of Medicare hospital spending on chronically ill seniors may be unnecessary and fails to improve the quality of care provided to beneficiaries. This research underscores the importance and continued need for promoting and enhancing value-based purchasing tools in the new Medicare prescription drug benefit and throughout the entire system, the Pharmaceutical Care Management Association (PCMA) said today.

“Today’s findings from the Dartmouth Atlas Project have important implications for the new Medicare prescription drug benefit,” said PCMA President Mark Merritt. “As we well know from these and other data, there are human and economic costs associated with an unaccountable fee-for-service model. Pharmacy management tools are essential to improving outcomes, reducing variations in care, and ensuring value-based purchasing, particularly for seniors and the disabled. For these reasons, policymakers should resist ongoing efforts to erode these tools in the Medicare drug benefit and turn back the clock to a system with no regard for the real dangers associated with misuse, overuse, and underuse of prescription drugs.”

PCMA believes strongly that a broad-based consensus is emerging about the need to evaluate competing drug therapies and better utilize scarce health care resources. PBMs have been at the forefront of these efforts, especially through pharmacy & therapeutics (P&T) committees and a wide range of pharmacy management tools, including multi-tier formularies, step therapy, and prior authorization. PCMA has been supportive of a wide-range of private and public efforts to improve the information available to consumers, clinicians, and purchasers, including:

The Agency for Healthcare Research and Quality (AHRQ) is in the midst of a multi-year comparative effectiveness review, AHRQ’s Effective Health Care Program, examining a number of drug classes and therapies that has drawn widespread praise from across the political spectrum. The link is http://effectivehealthcare.ahrq.gov/aboutUs/index.cfm.

Consumers Union has launched an initiative, “Best Buy Drugs,” delivering consumer-friendly information about competing drug therapies for a wide range of common conditions. The link is http://www.crbestbuydrugs.org/.

AARP has launched a website providing comparative information to consumers about prescription drugs from the Drug Effectiveness Review Project (DERP) at the Oregon Evidence-based Practice Center. The link is http://www.aarp.org/health/comparedrugs/

Lastly, a diverse group, the Coalition for a Competitive Pharmaceutical Marketplace, which represents employers, insurers, and others, has been out front to remind policymakers about the need for continued access to a wide range of affordable and proven drug therapies and to oppose proposals that would increase prescription drug costs for consumers and purchasers with no corresponding benefit.
# # #

The Pharmaceutical Care Management Association (PCMA) is the national trade association representing America’s pharmaceutical benefit managers (PBMs). PCMA member companies provide pharmaceutical care management services to more than 200 million Americans.

Contact Information:
Phil Blando, 202-207-3614
Charles Coté 202-207-3605