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fafy
11-07-2006, 02:30 AM
Hi
Could anyone explain me what does "pharmacy benefit manager" mean? I'm stuck in the management it's a real nightmare. :eek:
Thank you.
Fafy

kavee
11-07-2006, 03:39 AM
Hi Fafy....

Pharmacy benefit manager is PBM....Manage care organisation(MCO) initiated to provide pharmacy benefits thru their own pharmacy departments which is being managed by PBM....

For example....I pay every month a nominal amount as deductible to Medical insurance from my salary,whether I go to hospital or not....So MCO what it does is it gives a list of physicians whom I can consult,Pharmacies from where I can fill prescriptions,it offers a prescription copayment plan and retrospective DUR....When I consult doctor I pay a nominal amount(copayment) and the rest is been payed by my insurance....On the whole PBM is to decrease the overall cost of healthcare......

Hope u have understood...

fafy
11-07-2006, 04:12 AM
Thank you Kavee you helped me a lot.
Where are you learning management from?
An other question for you: do you know if HMO are the only one to requiere a PCP or the non HMO (PPO, POS, EPO) also?

Ohm
11-07-2006, 01:13 PM
Hi Fafy

What Kavee said is about the Pharmacy Benefit Management is about the Demand side control of the cost of the Mediccin.

The overall aim of PBM is to decrease cost of the medicine and control the overall price of Health system by controlling varous parameters that are involved.

1st and foremost is the demand side controll, that's where the patient comes, by introducing copayments, dedcutbles, Co-insurence methods reduces the buying of medicin because in these mode of payment patient has to pay out of his pocket atleast someamount of money. So if there is minor illness, before patient spent money on, patient has to think to spent money from his pocket. So if the illness is not severe he try to avoid buying drugs, and it reduces the Cost that spent on Medicine.

Supply Side contorle, PBM's are very big organisations covering large areas in geography. They contact various Pharmaceutical companies, and have the discount price on drugs so automatically Pharmacies under PBM's benefit from the discount price. This is one method of suppy control. and another method of supply control is by restrictive formulary. If the doctors choose the drugs that are out of forumulary, and cost effective drugs they may not get the discount price at the end of the year. So this restrict the doctors from prescribing expencive medicine. So automatically the money spent on drugs will be decreased. But PBM"s plays same roles in Medicare, Medicaid but in different ways. But the aim of PBM is to contorl the drug cost and overall controll the health system cost. I hope this gave the brief idea, what to except in Medicare, and Medicaid about controlling price of drugs. Wish you all the best.

Best Wishes

Ohm

kavee
11-07-2006, 02:23 PM
Hey Fafy.....

I am studying mgmt from Manan shroff....Wat abt u?Hey I couldnt understand ur question.If someone understands hope they will answer.......



Thank you Kavee you helped me a lot.
Where are you learning management from?
An other question for you: do you know if HMO are the only one to requiere a PCP or the non HMO (PPO, POS, EPO) also?

kavee
11-07-2006, 02:28 PM
Hi ohm......

Thanx for the explanation.One more thing I didnt see anyone answering question....Its me Kavee:p who tried to answer....Anyways all the best..


Hi Fafy

What preeti said is about the Pharmacy Benefit Management is about the Demand side control of the cost of the Mediccin.


Best Wishes

Ohm

Ohm
11-07-2006, 03:02 PM
Hi Kavee

I am truly sorry, it was a mistake.it was you who answered not preeti, and your explanation is very good and understandble. Please don't mistake me, I am also studying from Manan, I just want to add up to your answer. Wish you very best.

Best Regards

Ohm

Hi ohm......

Thanx for the explanation.One more thing I didnt see anyone answering question....Its me Kavee:p who tried to answer....Anyways all the best..

kavee
11-07-2006, 03:16 PM
Hi Ohm.

No probs..Why tell sorry....We all r good friends.....So I just wanted to make it kiddish:) ....U too dont mind..All the best.


Hi Kavee

I am truly sorry, it was a mistake.it was you who answered not preeti, and your explanation is very good. Please don't mistake me, I am also studying from Manan, I just want to add up to your answer. Wish you very best.

Best Regards

Ohm

bva
11-07-2006, 03:35 PM
The example of PBM is Caremark Rx Inc.

monaellakany
11-07-2006, 08:22 PM
thank u ohm

fafy
11-07-2006, 09:11 PM
Thanks to all of you.
I'm also studying from Manan but I've surely missed some parts!!!
My other question was about the Premium Care Physician: what organizations beside HMO requires one?

hiPEBC
11-07-2006, 09:27 PM
Hi,

What is HMO?

fafy
11-07-2006, 10:23 PM
Health Maintenance Organization

monaellakany
11-08-2006, 03:49 AM
hi fafy,
regarding to my stay in usa i would think that every health plan u contract with u have 1st primary care doctor who have all ur record and medical profile and if somthing happen like u which to change it or u moved so u have also to change him the new plceshould contact the primary care doctor for ur medical file i am sure that in medicaid and i think that isthe way it goes with the others i will let u know if i know any thing else

phd-pharmaD
11-08-2006, 05:49 AM
hi, guys,
I have ppo health care insurance right now. it doesn't need a PCP if you do not want to.I do not know others.

monaellakany
11-08-2006, 07:02 AM
what i am sure of is if u are a medicaid then u should have primary care doctor