PHP4: DEVELOPING A COMPREHENSIVE PERFORMANCE MEASUREMENT DATA SET FOR PHARMACEUTICAL BENEFIT MANAGEMENT PROGRAMS

Abstract

Pharmaceutical benefit management (PBM) programs are key to the provision of prescription drugs among those enrolled in health plans. A recent survey of HMOs revealed 600 of 604 HMOs had a drug benefit; and only 57 HMOs of the 600 with a drug benefit did not provide prescription drug coverage through a PBM (PBMI, 2000). Several proposals have advocated use of PBMs to administer outpatient prescription drug benefits for Medicare enrollees. Thus, the demand for accountability and a means to evaluate performance of PBM programs is growing; yet a set of standardized indicators for evaluating PBM performance does not yet exist. OBJECTIVE: Explore the array of functions performed by PBMs and measures used to evaluate PBM performance. Recommend additional measures that should be considered toward development of a comprehensive measurement set for evaluating PBM activities. METHODS: MEDLINE and web searches were conducted to develop a summary of PBM functions and existing PBM-related indicators. Measures used in other performance measurement activities that could be modified to assess PBM performance also were identified. RESULTS: PBM activities fall into four major categories: (1) administrative and management, (2) drug use control, (3) cost containment, and (4) disease management. Monitoring costs and savings of using drug management programs is the main focus of PBM performance measurement to date. Several entities have participated in efforts to develop measures for evaluating pharmaceutical care, but none has defined a comprehensive set of performance measures. Additional measures that could be included in a comprehensive measurement set, falling into the four major categories of PBM activities, are suggested. CONCLUSIONS: A standardized, comprehensive set of performance indicators should be developed to enable public and private sector purchasing organizations to evaluate PBM services and the impact of these activities on quality of care and consumer satisfaction.