Analysis of Prescription Claims for Medications from Retail Pharmacies in TRICARE Region 2.

摘要

A prescription benefit is an essential component of any health care benefit and cost containment is essential to ensure the fiscal continuity of the benefit. Drug spending has increased at double-digit rates since 1995. The per member per year Average Wholesale Price of prescription drugs has increased 16. 8% in 1998, from $282.48 to $329.83. In addition, fraud and abuse account for between 10 and 20 percent of all health care costs. TRICARE is the military health care benefit. Within this system, beneficiaries have several choices from which to obtain prescription medications. These are the Military Treatment Facilities, The National Mail Order Pharmacy program, and retail pharmacies. This evaluation focuses on prescription claims from retail pharmacies in TRICARE Region 2. In Fiscal Year 1999, beneficiaries filed an average of 39,416 claims at a cost of over $18 million. The top 10 American Hospital Formulary System classes accounted for over 38% of these claims while the top 25 accounted for over 7O%. The number one AHFS class by total amount paid as well as the number of prescriptions filled was antidepressants. Within this class, Paxil, Prozac, and zoloft accounted for 9.3% of prescriptions at a cost of $l.7 million. The top 25 medication classes accounted for 35% of total expenditures and 21% of total prescriptions at a cost of over mill ion. Identification of high cost and high use medications will result in formulary improvements or prescription practice interventions that result in cost savings.