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The <br />Welch <br />Company <br /> <br />• <br />Pharmacy Management <br />-• Part five of six components of a Model for Nealfh Plan Review <br />-~ Phamtacy Management is the newest entry into the Model for Health Plan <br />Review. <br />Five years ago many health plans experienced pharmacy expense that was <br />less than 5% of total plan costs. Today that number is 15%+, and is <br />projected to be 30%+ by 2005. <br />Believe it or not this trend may not be completely detrimental. Many medical <br />procedures now enabled by pharmaceutical breakthroughs replace surgical <br />procedures at a lower overall cost. Then why all the fuss? <br />-~ The answer lies in the imbalanced delivery of pharmaceuticals in traditional <br />health plans. To correct this imbalance a thorough consulting engagement <br />will produce a pharmacoeconomic analysis using the following tools: <br />- Plan design review <br />- Formulary development /rebate assessment <br />Drug utilization review <br />- New drug therapy <br />- Exclusion medications <br />- Therapeutic mix <br />-- It is interesting to note that this latest entry into the Model for Health Plan <br />Review has the best data available. Pharmacy Benefit Managers (PBMs) <br />must produce extensive data to support medical treatment plans. <br />Therefore, plan sponsors like providers of service (physicians) can have <br />access to the same data. <br />The difference is, of course, the physician manages the patient's care, <br />while the plan sponsor manages the entire plan. We, like the physicians, <br />must be scientific with our approach to Pharmacy Management. <br />