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

Appendix B:
Interview Questionnaire

DEFINITION STATEMENTS:
For this effort, we want to separate consideration of “routine” and “revolutionary” pharmacological advances.
Routine is defined as an incremental improvement in diagnosis or management of a condition that is currently handled using similar approaches. Examples might be new formulation of an existing drug or a new drug with a profile similar to that of an existing drug.
Revolutionary involves a change in the paradigm for diagnosis or management. It may include the development of medical treatment for a disease formerly managed surgically (and vice versa), a new drug which is substantially different in potency or mode of administration or action, and introduction or extension of drug therapy to persons who were formerly treated expectantly or by nonmedical means.
In addition, we want to separate consideration of “medical necessity” and “coverage” decisions.
For this purpose, medical necessity involves decisions regarding/identified with a putative clinical need.
Coverage will refer to decisions intended to apply to larger numbers of yet unidentified patients.

THE QUESTIONNAIRE

A. WHAT'S DONE NOW IN YOUR ORGANIZATION
In regard to emerging pharmaceuticals or new indications for existing drugs, does your organization make rules and/or decisions internally? (Y / N) ….probe for how they are made…
a. National vs. local
b. Plan vs. PBM
c. Plan vs. Medical Group
d. Coverage
e. Indications for use
f. Medical necessity
f. Level of coverage (co-payment) for drug
h. Formulary inclusion
For those areas where you make rules and/or decisions, do you have policies and procedures in place and/or a structured process for considering and making decisions?

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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
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