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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.

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Accession: 046619128

Download citation: RISBibTeXText

PMID: 10718021

DOI: 10.1377/hlthaff.19.2.42

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