The ABC's of Managed Care - D, E, and F

Hello again everyone! Now that monsoon season is almost over in Ann Arbor, I'm ready to take off my poncho (just kidding, I don't actually wear a poncho) and start writing again. Last time we kicked it old school with A, B, and C of our tour through managed care. Bet you can guess what's coming next..

D: Dynamic - Managed care is a dynamic environment. Why you ask? Let's just take a quick look at a couple of snippets from the FDA's Press Announcements just this month:

• May 23, 2011 - FDA approves Incivek for hepatitis C
• May 20, 2011 - FDA approves Sutent for rare type of pancreatic cancer
• May 20, 2011 - FDA approves new HIV treatment
• May 13, 2011 - FDA approves Victrelis for Hepatitis C
• May 06, 2011 - FDA approves new treatment for rare type of pancreatic cancer (This is not the same drug as on May 20th!)
• May 02, 2011 - FDA approves new treatment for Type 2 diabetes

This doesn't even take into consideration the surprising number of new drug formulations that are constantly being approved. Each of these newly approved drugs and formulations has to be reviewed carefully and decisions must be made as to their place in therapy. Clearly, managed care organizations like Blue Care Network (BCN) have their hands full adapting to the ever-changing world of pharmacy.

E: Evidence-based medicine - One of the exciting things about managed care is that you are making decisions not just for one individual patient, but for an entire population of patients. This is where evidence-based medicine (EBM) comes into play. With so much on the line, clinical pharmacists at BCN have to delve deep into the literature to find the best evidence to support their clinical decisions. Some of the questions the clinical pharmacists have charged me with investigating have been pretty tough so far:

• What is the correct dose and interval for IVIG in the treatment of relapsing-remitting multiple sclerosis (RRMS) exacerbations?
• Should alemtuzumab (Campath) be used in MS? Or should the patient try fingolimod (Gilenya) first? Or natalizumab (Tysabri)?
• What evidence is there for IVIG in urticarial vasculitis? (We could only find less than 10 case studies in the literature of this!)

I never thought I would say this, but that EBM class we all dreaded P1 year is truly paying off. Thank you Dean Welage; we will miss you greatly!

F: Fun - You can't have a career in pharmacy without a little phun! I can honestly say that I've had a fantastic time so far at my internship at BCN. The atmosphere there is truly unique. The dress is casual. The coffee is flowing. And each computer is equipped with an instant messenging feature to allow quick, fun communication between co-workers. It's a pretty tight-knit group at BCN, and the fun atmosphere seems to cultivate a culture of hard-work, efficiency, and teamwork. In the words of arguably the most entertaining boss in the world, Michael Scott: "What is the single most important thing for a company? Is it the building? Is it the stock? Is it the turnover? It's the people. The people." Well said, Mr. Scott. It is the people at BCN who make it such a great place to work.

Well, that's it for this week's adventures in managed care.

Your homework for next week: be dynamic, have fun, and uh... don't forget your EBM.