Magazine article Drug Topics

On-Line Transparency: The New Trend for Managed Care

Magazine article Drug Topics

On-Line Transparency: The New Trend for Managed Care

Article excerpt

Some of the mystery of healthcare coverage is vanishing as managed care companies and pharmacy benefit management (PBM) firms post new information on the Internet. There it is available to those who care most-consumers, pharmacists, and physicians.

Humana Inc. recently announced that vital health-benefit information is now available to members on its Web site ( Members can see their individual claims history over a 24-month period, with charts and graphs showing prescription compliance. In addition, they can consult Humana's complete formulary for coverage of specific drugs, the amount of copayment, requirement for prior authorization, and limit for dispensing.

"We are providing personalized information to consumers, specific to their claim and benefits, as opposed to just a drug list," said David Steele, M.D., medical director of e-Health at Humana. "Through the rest of the year, we plan to provide more information, like lower cost share alternatives to certain medications, deductible balances, and drug interaction checks with current medications as well as OTCs."

"One message we hear from our salespeople," said Fred Brownfield, R.Ph., director of pharmacy and therapeutics at Humana, "is that members want to know they'll be able to get a medication and not have a 'gotcha' at the counter. If members have this information, they will use it as a way of figuring out cost alternatives. We try to get out of the middle and let the consumer and doctor decide."

"It's a proactive approach; it's full disclosure," said Steele. "We put the information in from our members before they get to the counter, providing them what they need to understand the situation better. We are committed to adding more functionality, more personalized services."

Express Scripts is also giving consumers more information. An upgrade of its Web site ( has summaries of its pharmaceutical and therapeutics (P&T) committee proceedings, providing the "thought process" on the choice of new drugs to be covered, under what circumstances, and at what level of copayment. Its current site also provides drug evaluations and interactions, drug comparisons and side effects, health conditions, and treatment options.

"This is one way of putting information out for public scrutiny," said Raulo Frear, Pharm. …

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