World Health Organization
 Collaborating Center on
 Pharmaceutical Policy

    Improving Access to and Use of Essential Medicines

  Contact Info  


Learn More About:

Medicines and Insurance Coverage (MedIC) Initiative



Glossary of Terms Used for Pharmaceuticals and Pharmaceutical Policies in Low- and Middle-Income Countries


Interventions to Change Prescribing In Managed Care

Managed care organizations (MCOs) are the predominant form of health care in most parts of the United States. A variety of strategies have been used by MCOs to contain escalating drug expenditures and to improve the quality of medication use. Drs. Steven Soumerai and Dennis Ross-Degnan of the DACP conducted a systematic review of studies that examined the effectiveness of interventions targeting medication use in the US managed care setting published prior to June 2001. This review was published in the American Journal of Managed Care. Key tools and intervention techniques that were identified in the review were also made available with the permission of the original study authors on the website of America’s Health Insurance Plans at|77|529.

Drs Soumerai and Ross-Degnan, working with visiting international fellow Christine Lu, have recently updated the systematic review to include published studies of interventions targeting medication use in the US managed care setting from July 2001 through January 2007. The current review identified two additional intervention types, namely computerized monitoring and collaborative care involving pharmacists. In addition, we have also reported formulary-related interventions (which were excluded in the previous review as there were too few to draw valid conclusions). We found a number of consistently effective interventions including one-to-one academic detailing, computerized alerts and reminders, pharmacist-led collaborative care, and multifaceted disease management. Further, changes in formulary tier-design and related increases in co-payments were associated with reductions in medication use and increased spending by patients. The dissemination of educational materials alone had little or no impact, while group education showed mixed results. Little is known about the cost-effectiveness and long-term outcomes of these interventions. Importantly, few well-designed, published studies have assessed the safety of formulary-related interventions despite their widespread use. However, some evidence suggests that increases in cost sharing reduce access to essential medicines for chronic illness. We have documented this critical review of the recent literature in the form of a manuscript submitted for consideration for publication.


Information from the Third International Conference for Improving Use of Medicines, ICIUM2011