Institutional framework for integrated Pharmaceutical Benefits Management: results from a systematic review

• Main Authors: Tomasz Roman Hermanowski, Aleksandra Krystyna Drozdowska, Marta Kowalczyk
• Format: Article
• Language: English
• Published: Ubiquity Press 2015-09-01
• Series: International Journal of Integrated Care
• Subjects: Pharmaceutical Benefits Management; Pharmacy Benefit Managers; generic substitution; generic drugs; online adjudication of pharmacy claims; e-Prescribing; integrated care
• Online Access: http://www.ijic.org/articles/2253

<strong>Objectives: </strong>In this paper, we emphasised that effective management of health plans beneficiaries access to reimbursed medicines requires proper institutional set-up. The main objective was to identify and recommend an institutional framework of integrated pharmaceutical care providing effective, safe and equitable access to medicines. <strong>Method: </strong>The institutional framework of drug policy was derived on the basis of publications obtained by systematic reviews. A comparative analysis concerning adaptation of coordinated pharmaceutical care services in the USA, the UK, Poland, Italy, Denmark and Germany was performed. <strong>Results: </strong>While most European Union Member States promote the implementation of selected e-Health tools, like e-Prescribing, these efforts do not necessarily implement an integrated package. There is no single agent who would manage an insured patients’ access to medicines and health care in a coordinated manner, thereby increasing the efficiency and safety of drug policy. More attention should be paid by European Union Member States as to how to integrate various e-Health tools to enhance benefits to both individuals and societies. One solution could be to implement an integrated “pharmacy benefit management” model, which is well established in the USA and Canada and provides an integrated package of cost-containment methods, implemented within a transparent institutional framework and powered by strong motivation of the agent.