Pharmaceutical Technology Assessment for Managed Care: Current Practice and Suggestions for Improvement

By Samuel A. Bozzette; Rebecca D'amato et al. | Go to book overview

2
A Review of Current Practices
For our review of current practices, we collected data through interviews and a literature review. We structured the interviews and literature review around five questions that are central to understanding the nature of current assessments for new pharmaceuticals, and how they translate into benefit language and individual coverage decisions:
Who decides to accept or reject new pharmaceutical technology, and how?
What decision options (e.g., “Exclude drug,” “Assign to high-cost tier,” and “Require prior authorization”) are considered?
What factors affect the timing and resources devoted to pharmaceutical technology assessment?
What types of evaluations are performed and what types of evidence do they use?
How are decisions implemented and the results monitored?

Prior to our data collection, we hypothesized relationships between organizational motivations for assessing a new technology and who, what, how, and when pharmaceutical technology assessments were conducted. For example, consider a preferred provider organization (PPO) with indemnity prescription drug coverage for all FDA-approved drugs. Such a provider would likely conclude that it only needs to determine whether a new drug is specifically excluded from coverage because of plan contract language (e.g., is considered a cosmetic or in another excluded-drug class). We would expect that such an assessment would be done with minimum effort and analysis, and that it would likely wait until after the drug becomes available. In contrast, an HMO with full financial risk for drug-benefit costs (i.e., risk contract), a tightly managed formulary, and an extensive authorization program would likely see itself as having much broader and more clinically detailed assessment needs. We would expect that this organization's assessment process would begin much earlier, perhaps even as a result of monitoring the progress of pre-market drugs; that it would probably take longer; and that more resources and more techniques would be brought to bear on the assessment.

In this section, we first describe the data collection that we designed to address these hypothesized relationships, then synthesize the findings.


Data Collection

We collected data about current practices for this study in two ways: (1) by qualitatively interviewing a purposive (i.e., nonrandom) sample of relevant organizations, and (2) by

-7-

Notes for this page

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this page

Cited page

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited page

Bookmark this page
Pharmaceutical Technology Assessment for Managed Care: Current Practice and Suggestions for Improvement
Table of contents

Table of contents

  • Title Page *
  • Preface iii
  • Contents v
  • Executive Summary vii
  • Acknowledgements xii
  • 1 - Introduction 1
  • 2 - A Review of Current Practices 7
  • 3 - A Framework and Approaches for Future Practice 26
  • 4 - Applying the Framework Practically 49
  • Appendix A - Annotated Bibliography 55
  • Appendix B - Interview Questionnaire 67
  • References 71
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this book

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this book
  • Bookmarks
  • Highlights & Notes
  • Citations
/ 74

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.