Pharmaceutical Pricing Practices, Utilization and Costs - Meeting Summary. 6. Research Questions: Pharmaceutical Utilization Issues


Conference participants suggested that the following questions might be addressed as part of a research agenda in the area of pharmaceutical cost pressures and trends:

  • What, if anything, can be done to help increase the value from prescription drug expenditures?
    • Are drugs in specific therapeutic classes being appropriately used? What are the criteria for appropriate use? What outcomes research might be conducted to understand better what constitutes appropriate use of prescription drugs?
    • Are drugs in specific therapeutic classes being inappropriately used--i.e., overused, misused, or underused? What are the criteria for inappropriate use? What accounts for this inappropriate use?
  • What are the characteristics of individuals most at risk for inappropriate prescription drug use? What are the costs and consequences of treating the sequelae of inappropriate prescription drug use?
  • If one defines the appropriate use of pharmaceuticals as "the right drug, for the right patient, taken in the right way, at the right cost," what could be done by the following parties to encourage the appropriate utilization of drugs by Medicare beneficiaries under a Medicare prescription drug benefit?
    • Pharmaceutical manufacturers;
    • Government agencies such as FDA, NIH, the Agency for Healthcare Research and Quality (AHRQ), and HCFA(now known as CMS);
    • Physicians;
    • Pharmacists;
    • Patients;
    • Managed care plans and PBMs; and
    • Large employers.
  • What effect does DTC advertising have on the utilization of brand-name prescription drugs? Are there differential impacts on people with good prescription drug coverage and those without it? How does it intersect with physician detailing and other strategies used to increase the utilization of specific products? What impact does DTC advertising have on physicians' prescribing patterns and patients' health outcomes?
  • What are the effects of various pricing- and utilization-focused cost-control strategies, both singly and in combination, that PBMs use to control the costs of their customers' prescription drug programs--e.g., rebates, mail service pharmacies, use of drug formularies, drug utilization review, disease management programs, and patient cost-sharing arrangements?
  • What role might disease management programs play in encouraging appropriate utilization and discouraging inappropriate utilization of prescription drugs among individuals with chronic medical conditions? What roles should physicians, pharmacists, PBMs, and patients play in disease management programs? What financial incentives are needed to help ensure the success of disease management programs? How should such programs be funded?
  • What information is needed to enable physicians, patients, and others to encourage the appropriate utilization of prescription drugs and discourage the inappropriate utilization of prescription drugs? What is the best way of developing and conveying this information? Can new technologies such as Internet and e-prescribing initiatives play a role in encouraging the appropriate utilization of prescription drugs?