Expansion of Managed Care Influence in Medicare and Medicaid Is Key Factor in Shifting Dynamics, According to a New Report from Decision Resources
November 18, 2013 - Burlington, Mass. –
Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds prescribing influencers are increasingly consolidated among managed care plans as the payers become more prevalent in public-sector markets. The Strategic Insights report entitled Shifting Dynamics in U.S. Prescribing Power: Who are the New Decision Makers?
finds that managed care’s controls over formularies and utilization is consolidating at the same time patients are assuming control of their own drug spending through high-deductible health plans and other benefit designs that require more patient out-of-pocket purchasing.
The findings reveal that more than half of the 60 million people enrolled in Medicaid in the United States are in managed care plans whose drug management is guided by the plans and associated pharmacy benefit managers. Three out of four U.S. citizens over 65 are enrolled in Medicare Part D plans with built-in formularies and networks. At the same time, hospital and physician consolidation has concentrated prescribing influencers among large, integrated health systems.
“As healthcare reform unfolds, an emphasis on efficiency, value and improved outcomes is changing prescribing dynamics,” said Decision Resources Group Principal Director Jane DuBose. “The accountable care movement transfers patient outcomes and financial risk to providers and it is crucial to identify not only the risk takers among prescribers but to understand the quality metrics that are guiding their behavior.”
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