| Prescription drugs represent one of the fastest growing component of healthcare spending. Typically, health plans have worked to control prescription costs through benefit design and formulary systems. A less restrictive alternative is to establish informational programs where pharmacists representing the plan present cost effectiveness data to physician groups. Health plan sponsored “detailing” programs have been implemented successfully in a number of small scale demonstrations. This study represents a large scale effort to rigorously determine the relationship between program success and: (A) The intensity of the program; (B) The degree to which the ratio of health plan patients to physician influence prescribing behavior; (C) The degree to which the ratio of managed care members to physician influence prescribing behavior; (D) The degree to which clinic characteristics influence prescribing behavior.; The detailing program designated preferred and non-preferred drugs in each of three classes. The effect of the program was measured using a pre- and post-intervention study design with a control group and a staggered implementation period. Claims data for three drug classes targeted by the plan, enrollment and encounter data from the health plan, and data from a survey of clinic directors and administrators were used in the analysis. Claims were extracted for a 3-year period, covering 9 months before and 9 months after the intervention for each clinic. A multinomial logit model for group data is used to measure change in market share for each drug. Explanatory variables include intensity of intervention, the ratio of patients to physician, and clinic characteristics.; The intensity of intervention was associated with an increase in prescribing for “preferred” agents and a decrease in prescribing of “non-preferred” agents. The number of managed care contracts and several other clinic characteristics moderated the effect of the intervention.; The findings suggest that providing cost-effectiveness information to physicians can have an effect on prescribing behavior. However, the relationship between the clinic and the health plan may amplify or dampen the effect of such an intervention. These programs must be viewed in the context of ongoing contractual relationships, benefit structures, and clinic policies rather than as a singular effort. |
