J Manag Care Pharm . 2007 Oct;13(8 Suppl C):S1-39.

    • PMID: 17970611

    Abstract

    The methods by which the U.S. health care system pays for prescription drugs have been subject to much attention and increased scrutiny in recent years. In particular, ground-breaking legislation has been enacted and regulations implemented that have changed the basis for payment for prescription drugs in the Medicare and Medicaid programs, and a number of precedent-setting court cases are likely to result in further modifications to drug payment methods used by public and private payers. These developments will have significant implications for many stakeholders beyond public and private payers; they will affect consumers' access to drugs, payment to pharmacists and other providers of drugs, and spending for the health care system as a whole. Recent debate centers on determining the most appropriate basis for calculating how payers, including government, employers, and health plans, should pay pharmacists and other providers for drugs. Historically, payment for prescription drugs has been based on benchmark prices that do not necessarily reflect the actual acquisition costs paid by providers, primarily pharmacists, physicians and hospitals. This has led policymakers to believe that Medicare and Medicaid have paid more than is necessary for prescription drugs, contributing to excess spending in public programs. Thus, in an effort to reform the payment system and reduce drug expenditures, policymakers have made changes to the benchmarks used by public programs to pay for drugs. Private payers are beginning to follow their lead by changing their own payment methods and benchmarks. However, the drug purchasing and distribution system within the United States is highly complex and involves multiple transactions among myriad stakeholders, including drug manufacturers, distributors, third-party payers, pharmacists, physicians, and patients. Any change in payment methods or benchmarks has significant implications for all stakeholders, affecting the payments and prices to and from each of these groups. Knowledge of the intricate distribution and payment systems for prescription drugs is essential in order to ensure that payment reform results in desired outcomes such as fair and equitable payment to providers while avoiding unintended consequences such as reduced access to drugs. The Academy of Managed Care Pharmacy (AMCP) recognized the need to help stakeholders and policymakers better understand, evaluate and navigate the profound changes occurring in payment for prescription drugs in the United States. This AMCP Guide to Pharmaceutical Payment Methods offers a comprehensive examination of the methodologies and price benchmarks that have been used in the public and private sector to pay for pharmaceuticals in the U.S., the changes that have occurred or are likely to occur in the future, and the forces that are behind these changes. AMCP has made every effort to make the Guide an unbiased presentation of information, issues, and implications.

    Publication types

    • Guideline

    MeSH terms

    • Health Expenditures / legislation & jurisprudence
    • Health Expenditures / standards
    • Humans
    • Information Dissemination / methods
    • Insurance, Pharmaceutical Services / economics*
    • Insurance, Pharmaceutical Services / legislation & jurisprudence
    • Managed Care Programs / organization & administration
    • Managed Care Programs / standards*
    • Medicaid / legislation & jurisprudence
    • Medicaid / organization & administration
    • Medicare / legislation & jurisprudence
    • Medicare / organization & administration
    • Prescription Fees / legislation & jurisprudence
    • Prescription Fees / standards*
    • Prospective Payment System / economics*
    • Prospective Payment System / legislation & jurisprudence
    • United States
    What are the three common payment types for drugs?
    AWP (Average Wholesale Price)
    • AWP is one of the most commonly used benchmarks in drug pricing.
    • Third-parties publish this price for public knowledge (First DataBank (FDB) and Medi-Span are the most widely used)
    more
    What is the most common type of drug test for employment?
    Urinalysis Urinalysis – A urine test is the most common form of pre-employment testing and is typically conducted once a conditional offer of employment has been sent. A urine test can show traces of drug use even after the effects of the drug have worn off and remain in the body for an extended period of time. more
    What personality type is most common?
    ISFJ Overall, the most common personality type is ISFJ This type occurs in 14% of the population. more
    Which personality type is most common?
    ISFJ Overall, the most common personality type is ISFJ This type occurs in 14% of the population. more
    Where is drug trafficking most common?
    According to the International Crisis Group, the most violent regions in Central America, particularly along the Guatemala–Honduras border, are highly correlated with an abundance of drug trafficking activity. more
    What type of drug is gabapentin?
    Gabapentin works in the brain to prevent seizures and relieve pain for certain conditions in the nervous system. It is not used for routine pain caused by minor injuries or arthritis. Gabapentin is an anticonvulsant. This medicine is available only with your doctor's prescription. more
    What type of drug is lorazepam?
    Lorazepam belongs to a group of medicines called benzodiazepines. It's used to treat anxiety and sleeping problems that are related to anxiety. It can be taken to help you relax before an operation or other medical or dental treatment. This is known as a "pre-med". more
    What are the 3 common payment types for drugs?
    AWP (Average Wholesale Price)
    • AWP is one of the most commonly used benchmarks in drug pricing.
    • Third-parties publish this price for public knowledge (First DataBank (FDB) and Medi-Span are the most widely used)
    more
    What type of drug is Klonopin?
    Clonazepam is a benzodiazepine. It is approved for the treatment of panic disorder (with or without agoraphobia), as well as certain types of seizure disorders. However, benzodiazepines are also commonly used to treat difficulty sleeping and alcohol withdrawal. more
    What type of drug is Xanax?
    Alprazolam is in a class of medications called benzodiazepines. It works by decreasing abnormal excitement in the brain. more
    What is H type drug?
    Schedule H is a class of prescription drugs in India appearing as an appendix to the Drugs and Cosmetics Rules, 1945 introduced in 1945. These are drugs which cannot be purchased over the counter without the prescription of a qualified doctor. more

    Source: pubmed.ncbi.nlm.nih.gov

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