Understanding Pharmacy Benefit Design – Essential For Integrated Care Coordination

As we move to integrated care coordination, there has been a change in accountability. And this accountability demands that managers of care coordination programs have a better understanding of how medications are paid for and cost containment models for pharmacy benefits.

We are seeing more models that are taking into account all costs (including pharmaceuticals) and not just the costs of specialty care — for example, the state of Arizona utilizes several integrated behavioral health and primary care programs for complex consumers. Under this model, all physical and behavioral health services, as well as pharmacy benefits, are contracted out to managed . . .