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
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.