Health Maintenance Organizations (HMOs)/Pharmacy Benefit Management Organizations (PBMs)/Managed Care Organizations (MCOs)

A key opportunity identified in a strategic planning meeting in 1994 by the Consortium for the Advancement of Medication Information, Policy and Research (CAMIPR) was the growing role for medication information specialists in the area of medication policy development/research and technology. Since pharmaceuticals account for approximately 10% of health care dollars, which is up from 7% 5 years earlier, this offers tremendous opportunities for the medication information specialist to provide leadership in the development and implementation of mechanisms to support the cost-effective selection and use of medications in HMOs, PBMs, and managed care organizations. The specialist may coordinate activities relating to formulary development and implementation, ADE reporting and analysis, and therapeutic guideline development. Medical and pharmaceutical outcomes research has been an increasing interest among health care providers, payers, and regulatory agencies. With appropriate training (e.g., specialized residency in medication information practice or managed care experience) and expertise, opportunities are growing for the medication information specialist in the insurance industry, HMOs, managed care organizations, pharmacy benefits management companies, state and national government agencies (e.g., Medicaid and Medicare), as well as other groups interested in the cost-efficient use of medications.

A pharmacist in any of these organizations has the opportunity to evaluate new information for medications on the market and assess its true value in a target group of patients. Prior to approval by the FDA, drugs undergo testing in a limited number of patients. Once approved, experience in patients escalates and previously unrecognized, rare adverse events may be identified. The drug may also be found to be useful for conditions not described in the labeling. Perhaps one of the most important functions of postmarketing surveillance is in the area of ADR reporting. This type of analysis can answer questions about drug interactions, identify potential new indications for the product, and study patients in a broader population. Organizations with a relatively large patient population offer opportunities to study these issues under the leadership of a medication information specialist.

Opportunities also exist to establish guidelines for selected disease states (e.g., management of patients with diabetes mellitus) or classes of drugs (e.g., selection of appropriate antibiotic for surgical prophylaxis). Practice guidelines are becoming an increasingly important part of the biomedical literature. These clinical guidelines are systematically developed to assist practitioners and patients with decisions about health care in an effort to improve the quality and consistency of health care while minimizing costs and liability. Evidence-based practice guidelines are developed through systematic reviews of the literature appropriately adapted to local circumstances and values. Key questions to consider when reviewing a practice guideline have been proposed. These questions primarily rely on how accurately the guideline reflects the research used to produce it. More information on therapeutic guidelines can be found in .