Highlights of the Second Annual P&T Society Meeting
Health Care Coat of Arms
Speaker: Jeffrey Lenow, MD, JD, Medical Director of JeffCARE, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Dr. Lenow, President of the P&T Society, opened the meeting by recounting some of his experiences in teaching medical school residents. These future doctors of America participated in an activity called the “Coat of Arms” exercise. In this exercise, participants outlined their vision of the most important parts of health care today and in the future. The main themes, which were illustrated in hand drawings of a coat of arms, were balance of cost and quality, the costs of pharmaceutical care, hope for unity inter-industry, the importance of new technology, the culture of safety/error management, social needs for improved access, a new era of accountabilty, and the new consumers.
Doctors today now know that they can’t afford to do anything they deem to be medically necessary, and they recognize that pharmaceuticals are a major factor in the cost-versus-quality issue. It is also important for them to realize that there are other people involved in health care besides physicians, and there are other industries involved too. Health care safety and medical errors are a subject of ongoing debate, as evidenced by the landmark Institute of Medicine (IOM) report, ‘To Err is Human.” Residents today recognize that with the high cost of medical school and the difficulties of earning money now compared to the days of earlier physicians, they have to want to be doctors for the right reasons. Consequently, they are more focused on the social mores and moral issues involved in health care delivery. In this new era of accountability, doctors’ futures will depend on how their performance is measured. People are now coming into their doctors’ offices with diagnoses and expectations; they want to be involved in their own care.
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Dr. Lenow also outlined the responsibilities of the P&T Society: to be a multidisciplinary force committed to responsible P&T education and the creation of appropriate policies; and to be a forum in which various industries with stakeholder interest in these health care issues can partner, using an evidence-based approach to health care.
Key Issues Facing the P&T Committee
Speaker: David B. Nash, MD, MBA, The Raymond C. and Doris N. Grandon Professor of Health Policy and Medicine at Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
Dr. Nash, editor-in chief of P&T and member of the board of directors of the P&T Society, discussed some of the important issues facing P&T committees in his welcome address. Dr. Nash focused on 12 key issues: direct-to-consumer (DTC) advertising, new pharmaceutical regulations dealing with physicians, reducing medical errors, state medicaid programs, tiered pharmacy benefits, discount programs, Agency for Health CERT programs (discussed below), pharmacogenomics, the Medicare drug benefit, the future of P&T committees, the role of managed-care formularies, and the future of pharmacoeconomics.
DTC advertising barely existed five years ago. The latest statistics for 2001 estimate that approximately $2.7 billion is spent on DTC advertising annually. The return on the investment is $3 to $4 for every dollar spent on this advertising, producing more of a profit than advertisements in medical journals.
Physicians are no longer being wooed with ringside seats and other lavish gifts from pharmaceutical companies. This might be an indirect benefit, because now they are forced to focus their energies on health care issues and pharmaceuticals, the core component of inpatient processing system errors. Medicaid programs, which account for a considerable percentage of prescriptions, will have less to spend in the wake of 9/11. Pharmacy benefits are growing to four, five, and six tiers as a result of increasing costs. However, little research has been done on the effects of these tiers. How are consumers reacting to them? Are we improving care or denying access?
Discount programs are another area of concern. These programs can come from the pharmaceutical industry, states, regional government, or private sector parties. Hardly anything has been published on these programs and their impact on health care.
The Center for Excellence in Research in Therapeutics (CERT) program functions under the auspices of the Agency for Health Care Research. The CERTs (which were discussed in the June 2001 editorial in P&T) are important loci for research on the effectiveness and cost of pharmaceutical agents.
With the advent of pharmacogenomics comes the prospect of precision prescriptions (also discussed in a P&T editorial, in the January 2001 issue). The future will involve a genetically focused armamentarium.