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Review
. 2005;83(1):131-47.
doi: 10.1111/j.0887-378X.2005.00338.x.

Drug insurance utilization management policies and "reference pricing": an illustrated commentary on the article by Vittorio Maio and colleagues

Malcolm Maclure  1
Affiliations
Review

Drug insurance utilization management policies and "reference pricing": an illustrated commentary on the article by Vittorio Maio and colleagues

Malcolm Maclure. Milbank Q. 2005.
No abstract available

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Figures

Figure 1
Figure 1
Insurance Is for Cost-Effective, Needed Use
Figure 2
Figure 2
Spectrum of Policies for Funding the Needy
Figure 3
Figure 3
Strategy 1: Use Drug Spending Data Only
Figure 4
Figure 4
Strategy 2: Use Evidence of Drug Safety, Effectiveness, and Price to Create List of Covered Drugs
Figure 5
Figure 5
Strategy 3: Use Drug Evidence, Prices, Plus Data on Patients to Set Different Copayments
Figure 6
Figure 6
Strategy 4: Prior Authorization: Waive Copayment if Data Show Patient Has Special Need
Figure 7
Figure 7
Annual Deductible (Strategy 1): Relation to the Patient's Sensitivity to Price Differences
Figure 8
Figure 8
Monthly Cap (Strategy 1): Relation to the Patient's Sensitivity to Price Differences
Figure 9
Figure 9
Fixed Coinsurance (Strategy 1): Patient or Second Insurer Pays a Fixed Percent of Drug Costs. Patient Is Sensitive to Price if He or She Copays.
Figure 10
Figure 10
Monthly Premiums (Strategy 1)
Figure 11
Figure 11
U.S. Medicare Program at a Glance
Figure 12
Figure 12
Formulary (Strategy 2): Patient Pays Full Price of Any Drug Not on Insurer's Approved List
Figure 13
Figure 13
Three-Tier Copayments (Strategy 3): Patient Pays 1 of 3 Flat Fees. Insurer Pays the Rest.
Figure 14
Figure 14
Maximum Allowable Cost (MAC) (Strategy 3). Patient Pays Extra Cost above a “Reference Price.”
Figure 15
Figure 15
Three-Tier Coinsurance (Strategy 3). Patient Pays Lower Percent for Preferred Drugs.
Figure 16
Figure 16
Prior Authorization (Strategy 4) within a Formulary: Insurer Pays if Need Is Documented
Figure 17
Figure 17
Prior Authorization (Strategy 4) within a Maximum Allowable Cost (MAC): Insurer Pays Full Price if Need Documented
See this image and copyright information in PMC

Comment on

References

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    1. Bowyer S, McQueen N On Behalf of Employer Committee on Health Care in Ontario (ECHCO) Toronto Commission Consultations, May 31, 17. Saskatoon: Commission on the Future of Health Care in Canada; 2002. [accessed January 11, 2005]. appendix to Building on Values: The Future of Health Care in Canada, by R.J. Romanow Available at http://www.hc-sc.gc.ca/english/pdf/romanow/pdfs/Toronto_Day_1_E.pdf.
    1. Canadian Institute for Health Information. Spending on Prescribed Drugs Continues to Increase. 2003. [accessed January 11, 2005]. Available at http://secure.cihi.ca/cihiweb/en/media_23apr2003_fig4_e.html.
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    1. Grootendorst PV, Dolovich LR, Holbrook AM, Levy AR, O’Brien BJ. [accessed January 11, 2005];The Impact of Reference Pricing of Cardiovascular Drugs on Health Care Costs and Health Outcomes: Evidence from British Columbia. 2002 2 Technical Report SEDAP Research paper no. 71. Hamilton, Ont.: Social and Economic Dimensions of an Aging Population, McMaster University. Available at http://socserv.socsci.mcmaster.ca/sedap/p/sedap71.pdf.

MeSH terms