PBMs: reshaping the pharmaceutical distribution network

208 Pages·1998·83.819 MB·English

by  Healy, Elaine M., Lasagna, Louis, Shulman, Shelia R

Sheila R. Shulman
Elaine M. Healy
Louis Lasagna
Editors
PBMs:
Reshaping the Pharmaceutical
Distribution Network
PBMs: Reshaping the Pharmaceutical Distribution Network
has been co-published simultaneously as Journal ofP har
maceutical Marketing & Management, Volume 12, Num
bers 2/3 1998.
"T
Pre-publication his book would be of greatest in-
REVIEWS, terest to those interested in under
standing how patients receive pharma
COMMENTARIES,
ceutical therapies in this country. The
EVALUATIONS . .. pharmaceutical marketplace has been
reshaped in the 1990s through the rapid
development of employer-based phar
maceutical benefits, through the devel
opment of pharmaceutical benefit man
agers (PBMs) to manage these benefits,
and through integration. of PBMs with
pharmaceutical manufacturers in a rapid
series of controversial mergers.
This book presents a comprehensive
overview of the pharmaceutical benefit
industry today, both the design and
structure of PBMs, the legal implications
of PBM management practices, the legal
ramifications of PBM-pharmaceutical man
ufacturer mergers, and the implications
of these networks on pharmacies them
selves.
More pre-publication
!&VIEWS, COMMENTARIES, EVALUATIONS.
The work is clear and interesting
and represents several competing
perspectives on these issues. For
readers with little knowledge of the
area, the work will serve as an im
portant introduction to the topic. For
readers with a working knowledge
of the field, the up-to-date legal re·
views may be of most interest.
PBMs are rapidly evolving orga
nizations. However, their design
and current role in the marketplace
is fraught with ethical issues. This
work helps the reader to under
stand some of the issues leading to
these concerns."
Kevin A. Schulman, MD
Director
Clinical Economics Research Unit;
Associate Professor ofM edicine
Georgetown University Medical Center
Washington, DC
The Pharmaceutical Products Press
( •, ~r I (~I <y< I 'l"' I (~I (y( I
PBMs:
Reshaping the Pharmaceutical
Distribution Network
PBMs: Reshaping the Pharmaceutical Distribution Network has
been co-published simultaneously as Journal ofP harmaceutical
Marketing & Management, Volume 12, Numbers 2/3 1998.
The Journal ofP harmaceutical Marketing & Management Monographs/
"Separates"
Marketing Pharmaceutical Services: Patron Loyalty, Satisfaction,
and Preferences, edited by Harry A. Smith
and Stephen Joel Coons
Promotion ofP harmaceuticals: Issues, Trends, Options,
edited by Dev S. Pathak, Alan Escovitz, and Suzan Kucukarslan
Pharmaceutical Marketing in the 21st Century,
edited by Mickey C. Smith
PBMs: Reshaping the Pharmaceutical Distribution Network,
edited by Sheila R. Shulman, Elaine M. Healy,
and Louis Lasagna
These books were published simultaneously as special thematic issues of
the Journal of Pharmaceutical Marketing & Management and are avail
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PBMs:
Reshaping
the Pharmaceutical
Distribution Network
Sheila R. Shulman
Elaine M. Healy
Louis Lasagna
Editors
PBMs: Reshaping the Pharmaceutical Distribution Network has
been co-published simultaneously as Journal ofP harmaceutical
Marketing & Management, Volume 12, Numbers 2/3 1998.
The Pharmaceutical Products Press
An Imprint of
The Haworth Press, Inc.
New York • London
Published by
The Pharmaceutical Products Press, 10 Alice Street, Binghamton, NY 13904-1580 USA
The Pharmaceutical Products Press is an imprint of The Haworth Press, Inc., 10 Alice Street, Bing
hamton, NY 13904-1580 USA.
PBMs: Reshaping the Pharmaceutical Distribution Network
has been co-published simultaneously as Journal of Pharma
ceutical Marketing & Management, Volume 12, Numbers 2/3
1998.
© 1998 by The Haworth Press, Inc. All rights reserved. No part of this work may be reproduced or
utilized in any form or by any means, electronic or mechanical, including photocopying, microfilm
and recording, or by any information storage and retrieval system, without permission in writing
from the publisher. Printed in the United States of America. Reprint _ 2007
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However, the publisher, employees, editors, and agents of The Haworth Press and all imprints of
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use of materials or information contained in this work. Opinions expressed by the author(s) are not
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Cover design by Thomas J. Mayshock Jr.
Library of Congress Cataloging-in-Publication Data
PBMs: reshaping the pharmaceutical distribution network I Sheila R. Shulman, Elaine M. Healy,
Louis Lasagna, editors.
p. cm.-(Journal of pharmaceutical marketing & management: v. 12, no. 213)
"Co-published simultaneously as Journal of pharmaceutical marketing & management,
volume 12, numbers 213 1998."
"Proceedings of a roundtable on PBM issues sponsored by the Tufts Center for the Study of
Drug Development, Tufts University, October 24, 1996"-P.
Includes bibliographical references and index.
ISBN 0-7890-0512-3 (alk. paper)
I. Drugs-Marketing--Congresses. 2. Pharmaceutical industry--Congresses. I. Shulman,
Sheila R. II. Healy, Elaine M. Ill. Lasagna, Louis, 1923- . IV. Journal of pharmaceutical marketing
& management. V. Series.
[DNLM: WI J0829H v. 12 no. 213 1998 I W 265 AA I P3 1998)
HD9665.5.P374 1998
380.1 '456151-DC21
DNLMIDLC
for Library of Congress 98-12622
CIP
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PBMs:
Reshaping the Pharmaceutical
Distribution Network
Proceedings of a Roundtable on PBM Issues
Sponsored by the Tufts Center for the Study
of Drug Development, Tufts University, October 24, 1996
CONTENTS
Foreword xi
Henry Grabowski
PBMs of the 1990s: Why They Deserve a Second Look
Sheila R. Shulman
Louis Lasagna
Placing PBMs in Context 7
Wilbur B. Pittinger
How PBMs Work 15
Margaret McGlynn
PBMs: A Purchaser's Perspective 29
Robert J. Rubin
Anne Hawk
Elisa Cascade
A Perspective from the Food and Drug Administration 43
Mary Pendergast
A Perspective from the General Accounting Office 51
John C. Hansen
The PBM Industry: Is It Reinforcing the Shift to Centralized
Decision Making? 55
Henry Blissenbach
The Effect ofPBM Clinical Programs and Services
on Access to Prescription Drug Coverage 61
J. Russell Teagarden
Off-Label Indications, Expensive Therapies, Fast-Track
Drugs: How Do PBMs Structure Prior Approval,
Prescribing Restrictions, and Appeal Procedures? 71
Michael Manolalds
Legal Issues Arising from Managing the Pharmacy Benefit 77
Ann Tobin
Rebekah Crosby
A Framework for Research and Evaluation into the Effects
of Managed Care on the Pharmaceutical Marketplace 10 9
Bonnie B. Wilford
Statistical Appendix. Private Managed Care:
Issues and Trends 117
Richard Fehring
Appendix A. Minefields for the Unwary: Fraud and Abuse
Issues Affecting Pharmaceutical Manufacturers 125
Elizabeth B. Carder
Joseph W. Metro
Appendix B. The Impact of Drug Manufacturer Acquisitions
ofPharmacy Benefit Management Companies. Volume I:
Effects and Recommendations 145
John Coster
Appendix C. The Effects ofPBMs on the Marketplace:
A Pharmacy Perspective 177
Calvin J. Anthony
Index 181