+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Managing the pharmacy benefit in Medicare HMOs: what do we really know?



Managing the pharmacy benefit in Medicare HMOs: what do we really know?



Health Affairs 19(2): 42-58



An estimated five million Medicare beneficiaries received outpatient prescription drug benefits through Medicare + Choice in 1999. However, little is known about how these benefits are managed or about their effects on costs and quality of care. This exploratory study applies a case-study methodology to four large Medicare health maintenance organizations (HMOs) to identify and assess drug-use management strategies. It also poses a number of important issues for consideration by both policymakers and health services researchers, as the debate rages on over the creation and administration of a Medicare outpatient drug benefit, especially in light of the predilection for the use of private pharmacy benefit managers (PBMs) in many of these proposals.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 046619128

Download citation: RISBibTeXText

PMID: 10718021

DOI: 10.1377/hlthaff.19.2.42


Related references

Do Medicare HMOs and Medicare FFS differ in their use of the Medicare hospice benefit?. Hospice Journal 14(1): 1-12, 1999

Veterans' Pharmacy and Health Care Utilization Following Implementation of the Medicare Part D Pharmacy Benefit. Medical Care Research and Review 74(3): 328-344, 2017

VA-Medicare dual beneficiaries' enrollment in Medicare HMOs: access to VA, availability of HMOs, and favorable selection. Medical Care Research and Review 62(4): 479-495, 2005

Pharmacy students' knowledge of the Medicare drug benefit and intention to provide Medicare medication therapy management services. American Journal of Pharmaceutical Education 71(3): 41, 2007

PBMs to the rescue? Pharmacy benefit managers will play a key role in the Medicare drug benefit. What does it mean for the industry, consumers and Uncle Sam?. Modern Healthcare 35(48): 26-8 30, 2005

3 strategies for managing retiree costs. Employers are using point-of-service plans, flexible benefits, and Medicare-risk HMOs. Business and Health 12(4): 41, 1994

Pharmacy benefit managers: a model for Medicare?. Issue Brief 2001(765): 1-12, 2001

Pharmacy and Therapeutics Committee implications of the Medicare drug benefit. Managed Care Interface 17(3): 42-43, 2004

Medicare diabetes education benefit: HCFA plan excludes pharmacy. Journal of the American Pharmaceutical Association 38(4): 393-394, 1998

Managing injectable drugs: an evolving challenge for pharmacy benefit managers. Managed Care Interface 15(12): 15-16, 2002

How the Medicare Part D drug benefit changed the distribution of out-of-pocket pharmacy spending among older beneficiaries. Journals of Gerontology. Series B Psychological Sciences and Social Sciences 65(4): 502-507, 2010

Helping Medicare patients benefit from the new Medicare drug benefit: an overview with practice tips. American Journal of Geriatric Cardiology 14(6): 291-297, 2005

What can be learned about the ethical soundness of Medicare HMOs from studies comparing them to fee-for-service Medicare?. Journal of Ethics Law and Aging 5(1): 29-49, 2001

Medicare beneficiaries more likely to receive appropriate ambulatory services in HMOs than in traditional medicare. Health Affairs 32(7): 1228-1235, 2013

Medicaid & Medicare: HCFA must monitor HMOs to ensure appeal rights for Medicare beneficiaries. Journal of Law Medicine and Ethics 26(3): 253-254, 1998