약제비 절감방법

이라는 제목아래 미국의 조지타운대에 근무하는 교수가 그 방법에 대하여 paper 서치를 통해 나름대로 정리해놓은논문임..총제적으로 문제를 파악하기에 좋은 논문같음..이자료로 세미나 하는것이 어떨지..124쪽이 전부..

-- Utilization Strategies--

1. Direct Limits

a. Exclusion of specific drugs or drug classes from coverage
b. Exclusion of over-the-counter drugs from coverage
c. Dispensing limits (quantity limits) for a particular drug or prescription
d. General limits or caps on the quantity of drugs covered
e. Concurrent (prospective) drug utilization review

2. Utilization Management Approaches

a. Prior authorization requirements
b. Step therapy or fail-first requirements
c. Therapeutic substitution or therapeutic intervention
d. Closed formulary
e. Preferred drug list or open formulary
f. Mandatory generic substitution
g. Management of specialty drugs
h. Provider financial incentives
i. Payments to pharmacies as incentives
j. Other coverage management approaches

3. Cost Sharing Approaches

a. Copayments as a general strategy
b. Tiered copayments in general
c. Three-tiered copayments
d. Four-tiered or other more complex copayment structures
e. Coinsurance
f. Reference pricing

4. General Utilization Review Strategies

a. Retrospective drug utilization review
b. Physician profiling
c. Drug utilization review targeted to high-cost users
d. Disease management

5. Education Strategies

a. Education of consumers and physicians on the benefits of generic drugs
b. Education of consumers and physicians on the appropriate use of particular drugs
c. Counter detailing or academic detailing
d. Development of unbiased information on the appropriate use of certain drugs

-- Pricing Strategies--

6. Pricing Approaches Available to All Payers

a. Use of purchasing pools
b. Higher rebates through market leverage
c. Requirements to make prices and rebates transparent
d. Lower dispensing fees to the pharmacy
e. Use of restricted pharmacy networks
f. Use of discount cards
g. Defined contribution approaches

7. Lower Transaction Costs

a. Incentives for increased use of mail-order pharmacies
b. Mandatory mail order for maintenance medications

--Regulatory Strategies Available Only to Government--

8. Pricing Approaches

a. Expanded access to Medicaid rebates or changes to the rebate formula
b. Direct price regulation
c. Expanded access to the federal supply schedule

9. Direct Regulatory Approaches

a. Broader availability of generic drugs through changing patent protection laws
b. Broader authority to move drugs to over-the counter status
c. Increased regulation of direct-to-consumer advertising
d. Reduced restrictions on importation of drugs from other countries

Appendix A. Literature Reviewed