Twenty ten, or two thousand ten, however you choose to say the year we currently are living in, marks the 20^th anniversary of AMCP’s Foundation for Managed Care Pharmacy.   For the first ten years of our existence, FMCP existed only on paper. In the late 1990’s, the current AMCP Board of Directors felt that there was a significant need in the marketplace to have their foundation known as the Foundation for Managed Care Pharmacy, come to life and conduct research and education that would serve to advance the mission of AMCP and improve the public health. Michael Dillon, AMCP Past President was hired as the first Executive Director of FMCP and he began the monumental task of building FMCP. Joining FMCP in 2000, Steve Avey, also a past president of the Academy, continued to grow the work of FMCP, working tirelessly on projects such as the Framework for Quality Drug Therapy, the summer student internships and the AMCP Format for Formulary Submissions. It is hard to believe that FMCP has only actively been in the business of improving the public health for the past 10 years, even though we are 20 years old.

 

However, not being one to shy away from a reason to celebrate, combined with our official beginning in 1990, the Foundation for Managed Care Pharmacy is taking time this year to celebrate this significant anniversary. There are many special events planned, one of them being the launch of a series of articles on “Healthcare Leadership”, a key area of focus for the FMCP. 

 

During the year, FMCP will interview key leaders in healthcare and share their experiences, thoughts and advice on what the future holds for managed care pharmacy. For our first interview in the FMCP Healthcare Leadership Series, I had the privilege of interviewing FMCP’s newest Trustee, Perry Cohen.

 

Perry is no stranger to managed care pharmacy. He is a founder, Past President and fellow of the Academy, and he was also instrumental in forming the foundation. Dr. Cohen is co-founder and President of The Pharmacy Group, in Glastonbury, CT. He has over 30 years experience in healthcare, designing and managing pharmacy benefit management programs for payers.

 

Ten years ago Perry authored an article that appeared in the May 2000 edition of Managed Healthcare. The article was entitled “PBMS – Performance at the half” and in the article he shared the history of the PBM industry (1990 to 2000) and his thoughts regarding the changes coming (2000 to 2010). You will find that his predictions ring amazingly true, technology being in the front row as well as the growth of consumer-centric healthcare.

 

I asked Perry several questions regarding what he foresaw over the next ten years for our healthcare business and here is what he shared in our first edition of the FMCP Healthcare Leadership Series.

 

Perry: During the next 10 years (2010 to 2020) specialty health benefit management for specific diseases (e.g., oncology benefit management) will be a key force in healthcare.   In addition to medical benefits and pharmacy benefits, a third benefit, the Specialty Health Benefit, will emerge. 

 

The evolution of health benefits looks like this. In 1970, there were medical benefits.   In 1990, pharmacy benefits emerged and there were two types of healthcare benefits, medical and pharmacy. Beginning in 2010, there is the need for a third benefit, the Specialty Health Benefit. 

 

 

Specialty Health Benefits will be driven by the medical device, diagnostic and pharmaceutical pipelines and there are a lot of dollars at stake.

 

Responding to escalating costs, employers, as payers of healthcare, and health plans, also as payers of healthcare will drive the change.

 

Specialty Health Benefits are required for diseases with unique treatments and are led by diagnostics. However, treatment for the disease is also necessary for there to be a need for specialty health benefits. Care management and utilization management are involved in specialty health benefits and it includes components of both medical and pharmacy benefits. For example, if an individual has multiple sclerosis, the first step in this specialty health benefit would be for the person to undergo genetic testing. Fortunately there are effective treatments for MS and close patient follow-up is required in order to maximize the value of the treatment and enable the patient to live a better life.

 

Specialty Health Benefits will be needed by only a small percentage of the population, but their needs are unique and require new solutions, not old solutions to new problems.

 

Vaccines may also be placed under specialty health benefits.

 

Under the medical benefit “tent” originating in the 70’s, we find doctors, nurses and hospital pharmacists involved in the care of the patient. With the addition of the pharmacy benefit “tent” and the birth of the PBM industry in the 1990’s, we find the community pharmacist involved in patient care and the distribution of medications. Going forward, the Specialty Health Benefit tent will require a new type of healthcare professional, a topic that is still fairly ambiguous. It is not clear who owns this tent, but the payer is clearly involved and may emerge as the innovator in tracking the patient.   We do know that specialty health benefit management will require bridges to be built among all the tents in order for the consumer to benefit. Twenty ten may be a renaissance for all health care professionals coming together.

 

Comparative effectiveness plays a key role in the successful management of specialty health benefits. Evaluating the evidence and determining if the specialty health path is better than the medical benefit or pharmacy benefit alone will be critical.

 

FMCP started 20 years ago in order to conduct research in managed care pharmacy practices such as formulary management, dossiers, utilization management and disease management. Much is now known about these practices.

 

Just as FMCP has delivered useful information to the marketplace regarding pharmacy benefit management, future efforts of the foundation involve breaking new ground and conducting research on the next wave of how drugs are used.   The focus needs to be on drug therapy and the patient.

 

So there you have it, the first forward looking interview in the newly created FMCP Healthcare Leadership Series. I would like to thank Perry Cohen for taking the time to share his thoughts and the FMCP Board of Trustees hopes you find this information thought provoking and useful in your practice.

 

Stay tuned for our next interview in this series to see what other leaders in healthcare have to say about the future.  

 

Additionally, as a part of our focus on healthcare leadership, FMCP donors should watch for information regarding the Inaugural Steven G. Avey Award Lecture in Healthcare Leadership to be held in San Diego on Thursday evening, April 8, 2010. The 2010 recipient of the Steven G. Avey Award, the most prestigious award in managed care pharmacy honoring a lifetime of achievement, will deliver the first lecture in this new event.