Access, Affordability and Outcomes:
The Value of Managed Care Pharmacy — #AAOReport

The health care sector plays a crucial role in the everyday lives of millions of Americans, yet many are left puzzled about how it all works. One key player in this complex system is managed care pharmacy, which operates largely behind the scenes but significantly shapes our access to and affordability of prescription medications. Curious to uncover the intricacies of how this vital component functions? Let’s dive in and explore the transformative impact it has on your health care experience!

In its second year, AMCP's annual Access, Affordability, and Outcomes report looks at the fundamental concepts of managed care pharmacy and provides insight and clarity into how today's changing health care climate can be navigated to improve patient care and outcomes. It discusses key areas of focus such as: 

• The current state of prescription spending.
• Key statistics on health insurance and prescription drug coverage.
• Prescription utilization and out-of-pocket spending.
• Managed care pharmacy tools and their impact.
• Pharmacy types and pharmacy networks.
   

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Key Highlights

• Patients’ savings varied from mail order pharmacies to community pharmacies (with a 90-day supply), depending on the types of medications they use.
   
• When patients use mail order pharmacies to receive their medication in 90-day supplies:
  
  For brand medications reimbursed by commercial payers, average patient savings was 13%.
  For generic medications reimbursed by commercial payers, average patient savings was 22%.
  For brand medications reimbursed by Medicare, average patient savings was 12%. 
   
• When patients use community pharmacies to receive their medication in 90-day supplies:
  
  For brand medications reimbursed by commercial payers, average patient savings was 32%.
  For generic medications reimbursed by commercial payers, average patient savings was 23%.
  For brand medications reimbursed by Medicare, average patient savings was 7%. 
   
• Patients using mail-order pharmacies for 90-day supplies had the highest therapy adherence, 83% of patients using mail order pharmacies reached minimum days covered standards, higher than other dispensing methods.
   
• Our analysis also found there are significant differences in cost for specialty drugs driven by the site of care. When comparing three physician-administered drugs (Prolia, Entyvio and Ocrevus) being prescribed in different settings, we found significantly higher costs to plan sponsors in the HOPD setting relative to the pharmacy setting. When administered in an office setting, the difference in cost to plan sponsors was less pronounced and varied by drug.