Pharmacoeconomics, prescribing and the reimbursement of pharmaceuticals

The increasingly competitive nature of the US health system is requiting health care systems to take a much closer look at the impact, in both cost and outcome terms, of introducing new drugs or retaining existing drugs on formulary. Increasing attention is being given to proposals for disease management partnerships between health care providers and drug manufacturers or specialist intermediaries such as claims processors. These forms of vertical integration through contract (and ownership) require a system perspective to be taken in any drug evaluation. In pharmacoeconomic evaluation terms this represents what may be usefully described as a paradigm shift: a transition from the traditional, partial drug evaluation techniques implicit in cost-effectiveness and cost-utility analyses (where drug A is contrasted to drug B) to general or equilibrium assessments where full account is taken, by disease and therapy intervention areas within health care delivery systems, of the cost-outcome impacts of drug and other interventions. If these evaluations are to be undertaken with a view to increasing the efficiency and effectiveness of health care delivery, in the decision to list and reimburse particular drug products, then both manufacturer, s and purchasers of such products need to be aware of the most appropriate analytical frameworks for drug impact assessment and the data requirements to underpin such assessments. Additionally, the issue of drug related problems and the prescribing process need to be incorporated. A discussion as to the economic impact of this problem will be presented which ultimately has a major effect on the overall cost-effectiveness of drug therapy and resultant disease management. Unfortunately, the analyses of drug- related problems and the impact on drug therapy is not always considered by pharmacoeconomic researchers when undertaking the evaluation of drug therapy within the context of disease management.