Development and application status of pharmacy benefit management: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Xinyi ^1,2 , HE Liyue ¹ ,  YANG Li ¹

1. School of Public Health, Peking University, Beijing, 100191, P.R.China;
2. School of Public Health, Fudan University, Shanghai, 200032, P.R.China;

Corresponding author：

YANG Li, Email: lyang@bjmu.edu.cn

Keywords：

Pharmacy benefit management; Drug expenses; Disease management; Application

DOI：

10.7507/1672-2531.201811061

Video：

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Objectives To systematically review the concept, definition, development, operation mechanism, function, efficacy, advantages and challenges of pharmacy benefit management (PBM), in order to provide evidence for its introduction and application in China.Methods PubMed, EMbase, Web of Science, CNKI, WanFang Data and CBM databases were searched to collect literatures on researches, policies, and applications related to PBM from January 1^st, 2000 to January 1^st, 2017. Two researchers independently screened literatures, extracted data and used the AHRQ evaluation list to evaluate the quality of the observational studies, then qualitative method was used to review literature.Results A total of 12 researches were included. The results showed that PBMs had played an important role in negotiation discounts with drug manufacturers, supervising drug circulation and doctors' prescription behaviors, delivering health management services for patients, prescription payments with highly information-oriented systems, etc., which, as a result, could reduce the medication burden of patients with superior diseases management.Conclusions China's attempt to adopt a PBM model must take full account of practical conditions, which involves health management system, pharmaceutical market environment and social culture. It cannot merely emulate the PBM model of the United States. With consideration of local conditions, China can explore a suitable path for its own PBM model.

Citation： LIU Xinyi, HE Liyue, YANG Li. Development and application status of pharmacy benefit management: a systematic review. Chinese Journal of Evidence-Based Medicine, 2019, 19(5): 595-601. doi: 10.7507/1672-2531.201811061 Copy

1.	赵雯. 药品福利管理在我国医疗保险和商业健康保险中的运用. 成都: 西南财经大学, 2014.
2.	高红玉, 周利生. 美国药品福利管理模式的科学价值及其在我国的应用. 价格理论与实践, 2014, (5): 100-102.
3.	Mullins CD, Wang J. Pharmacy benefit management: enhancing the applicability of pharmacoeconomics for optimal decision making. Pharmacoeconomics, 2002, 20(1): 9-21.
4.	曾宪涛, 刘慧, 陈曦, 等. Meta 分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
5.	McPherson T, Fontane P, Iyengar R, et al. Utilization and costs of compounded medications for commercially insured patients, 2012-2013. J Manag Care Spec Pharm, 2016, 22(2): 172-181.
6.	Donohue JM, Papademetriou E, Henderson RR, et al. Early marketplace enrollees were older and used more medication than later enrollees; marketplaces pooled risk. Health Aff (Millwood), 2015, 34(6): 1049-1056.
7.	Carroll NV. A comparison of costs of Medicare Part D prescriptions dispensed at retail and mail order pharmacies. J Manag Care Spec Pharm, 2014, 20(9): 959-967.
8.	Wu N, Lee YC, Shah N, et al. Cost of biologics per treated patient across immune-mediated inflammatory disease indications in a pharmacy benefit management setting: a retrospective cohort study. Clin Ther, 2014, 36(8): 1231-1241.
9.	Fiscella RG, Lewis CC, Jensen MK. Topical ophthalmic fourth-generation fluoroquinolones: Appropriate use and cost considerations. Am J Health Syst Pharm, 2007, 64(19): 2069-2073.
10.	Sullivan PW, Nair KV, Patel BV. The effect of the Rx-to-OTC switch of loratadine and changes in prescription drug benefits on utilization and cost of therapy. Am J Manag Care, 2005, 11(6): 374-382.
11.	Khandelwal N, Duncan I, Rubinstein E, et al. Community pharmacy and mail order cost and utilization for 90-day maintenance medication prescriptions. J Manag Care Pharm, 2012, 18(3): 247-255.
12.	Brennan TA, Dollear TJ, Hu M, et al. An integrated pharmacy-based program improved medication prescription and adherence rates in diabetes patients. Health Aff (Millwood), 2012, 31(1): 120-129.
13.	French DD, Spehar AM, Campbell RR, et al. Advances in patient safety outpatient benzodiazepine prescribing, adverse events, and costs. Advances in patient safety: From research to implementation (volume 1: Research findings). Washington DC., Agency for Healthcare Research and Quality (US), 2005.
14.	Calabrese D. Comparing pharmacy benefit managers: moving well beyond the simple spreadsheet analysis. Am Health Drug Benefits, 2008, 1(5): 9-19.
15.	Harris KM, Thomas C. Naltrexone and pharmacy benefit management. J Addict Dis, 2004, 23(4): 11-29.
16.	Motheral BR, Heinle SM. Predictors of satisfaction of health plan members with prescription drug benefits. Am J Health Syst Pharm, 2004, 61(10): 1007-1014.
17.	胡海宁, 雷海潮. 美国药品利益管理公司的服务内容. 卫生经济研究, 2002, (3): 18-20.
18.	Meador M. Squeezing the middleman: ending underhanded dealing in the pharmacy benefit management industry through regulation. Ann Health Law, 2011, 20(1): 77-112.
19.	Rentmeester CA, Garis RI. Rebates and spreads: pharmacy benefit management practices and corporate citizenship. J Health Polit Policy Law, 2008, 33(5): 943-963.
20.	Bae JP, Justice PG. Pharmacy benefit management contracting: an assessment from a recent public sector procurement experience. J Health Care Finance, 2002, 29(1): 49-56.
21.	Stevenson JG, Bruhnsen K. Strategies to Improve PBM Management of an Employee Prescription Drug Plan. Am J Pharm Ben, 2015, 7(1): E10-E4.
22.	Olson J, Wickizer M. Outcome evaluation of a pharmacy benefit management-based asthma management program. Clin Sch Rev, 2015, 8(1): 102-129.
23.	Shrank WH, Porter ME, Jain SH, et al. A blueprint for pharmacy benefit managers to increase value. Am J Manag Care, 2009, 15(2): 87-93.
24.	Tsiachristas A, Cramm JM, Nieboer AP, et al. Changes in costs and effects after the implementation of disease management programs in the Netherlands: variability and determinants. Cost Eff Resour Alloc, 2014, 12: 17.

1. 赵雯. 药品福利管理在我国医疗保险和商业健康保险中的运用. 成都: 西南财经大学, 2014.
2. 高红玉, 周利生. 美国药品福利管理模式的科学价值及其在我国的应用. 价格理论与实践, 2014, (5): 100-102.
3. Mullins CD, Wang J. Pharmacy benefit management: enhancing the applicability of pharmacoeconomics for optimal decision making. Pharmacoeconomics, 2002, 20(1): 9-21.
4. 曾宪涛, 刘慧, 陈曦, 等. Meta 分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
5. McPherson T, Fontane P, Iyengar R, et al. Utilization and costs of compounded medications for commercially insured patients, 2012-2013. J Manag Care Spec Pharm, 2016, 22(2): 172-181.
6. Donohue JM, Papademetriou E, Henderson RR, et al. Early marketplace enrollees were older and used more medication than later enrollees; marketplaces pooled risk. Health Aff (Millwood), 2015, 34(6): 1049-1056.
7. Carroll NV. A comparison of costs of Medicare Part D prescriptions dispensed at retail and mail order pharmacies. J Manag Care Spec Pharm, 2014, 20(9): 959-967.
8. Wu N, Lee YC, Shah N, et al. Cost of biologics per treated patient across immune-mediated inflammatory disease indications in a pharmacy benefit management setting: a retrospective cohort study. Clin Ther, 2014, 36(8): 1231-1241.
9. Fiscella RG, Lewis CC, Jensen MK. Topical ophthalmic fourth-generation fluoroquinolones: Appropriate use and cost considerations. Am J Health Syst Pharm, 2007, 64(19): 2069-2073.
10. Sullivan PW, Nair KV, Patel BV. The effect of the Rx-to-OTC switch of loratadine and changes in prescription drug benefits on utilization and cost of therapy. Am J Manag Care, 2005, 11(6): 374-382.
11. Khandelwal N, Duncan I, Rubinstein E, et al. Community pharmacy and mail order cost and utilization for 90-day maintenance medication prescriptions. J Manag Care Pharm, 2012, 18(3): 247-255.
12. Brennan TA, Dollear TJ, Hu M, et al. An integrated pharmacy-based program improved medication prescription and adherence rates in diabetes patients. Health Aff (Millwood), 2012, 31(1): 120-129.
13. French DD, Spehar AM, Campbell RR, et al. Advances in patient safety outpatient benzodiazepine prescribing, adverse events, and costs. Advances in patient safety: From research to implementation (volume 1: Research findings). Washington DC., Agency for Healthcare Research and Quality (US), 2005.
14. Calabrese D. Comparing pharmacy benefit managers: moving well beyond the simple spreadsheet analysis. Am Health Drug Benefits, 2008, 1(5): 9-19.
15. Harris KM, Thomas C. Naltrexone and pharmacy benefit management. J Addict Dis, 2004, 23(4): 11-29.
16. Motheral BR, Heinle SM. Predictors of satisfaction of health plan members with prescription drug benefits. Am J Health Syst Pharm, 2004, 61(10): 1007-1014.
17. 胡海宁, 雷海潮. 美国药品利益管理公司的服务内容. 卫生经济研究, 2002, (3): 18-20.
18. Meador M. Squeezing the middleman: ending underhanded dealing in the pharmacy benefit management industry through regulation. Ann Health Law, 2011, 20(1): 77-112.
19. Rentmeester CA, Garis RI. Rebates and spreads: pharmacy benefit management practices and corporate citizenship. J Health Polit Policy Law, 2008, 33(5): 943-963.
20. Bae JP, Justice PG. Pharmacy benefit management contracting: an assessment from a recent public sector procurement experience. J Health Care Finance, 2002, 29(1): 49-56.
21. Stevenson JG, Bruhnsen K. Strategies to Improve PBM Management of an Employee Prescription Drug Plan. Am J Pharm Ben, 2015, 7(1): E10-E4.
22. Olson J, Wickizer M. Outcome evaluation of a pharmacy benefit management-based asthma management program. Clin Sch Rev, 2015, 8(1): 102-129.
23. Shrank WH, Porter ME, Jain SH, et al. A blueprint for pharmacy benefit managers to increase value. Am J Manag Care, 2009, 15(2): 87-93.
24. Tsiachristas A, Cramm JM, Nieboer AP, et al. Changes in costs and effects after the implementation of disease management programs in the Netherlands: variability and determinants. Cost Eff Resour Alloc, 2014, 12: 17.

Chinese Journal of Evidence-Based Medicine

Development and application status of pharmacy benefit management: a systematic review

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