Earticle

Formulary list that defines available drugs for use is developed to help physicians to select the most appropriate medication within a specific class of drugs under a specific health plan circumstances. Pharmaceuticals value can be maximized through sound formulary management. A positive list as a closed formulary type includes limited number of drugs reimbursed for preferred drugs only. Health plan is moving to more restrictive formulary system that has more strong power to control due to rising costs. In Korea, a positive list was implemented in Dec 2006, aiming at the appropriateness of pharmaceutical expenditure, under the drug expenditure rationalization plan. With the worldwide comparison of listing status for several products, Australia and New Zealand that implement a positive system have lower level in coverage than UK that has a negative system. At the point in time of UKyears with positive system, it is necessary to identify concerns and create possible solutions for its successful settlement. Formulary-based price control can be one of strategies to control drug expenditure, but it may jeopardize R&D of new drug, result in increased utilization of more costly alternatives, and not guarantee long-term savings to society. In a viewpoint of balancing of clinical effectiveness and cost-effectiveness as criteria for listing, economic evaluation is recommended to be used as a primary reference for optimal price to assure costeffectiveness when a drug is decided to include in the formulary list, rather than primary decision criteria for listing. Based on ultimate goal of positive system for efficient use of healthcare resource rather than reduction of drug expenditure itself, a range of effective mechanisms in the managed care pharmacy perspective that promote quality and optimal results such as drug utilization review and medical treatment guidelines should be considered to overcome the limitation of this system.

This research is based on the scope and definitions for Drug Utilization Review (DUR) program in the U.S., Code of Federal Regulation, Public Health (OBRA 90). An outpatient program includes prospective drug review, retrospective drug use review and an educational program. The goal of the DUR program must be to ensure appropriate drug therapy, while permitting sufficient professional prerogatives to allow for individualized drug therapy. A DUR program must access drug use information against predetermined standards. The source materials for predetermined standards development are consistent with peer reviewed medical literature and compendia such as American Hospital Formulary Service Drug Information, United States Pharmacopoeia-Drug Information and American Medical Association Drug Evaluations. The predetermined standards for prospective and retrospective DUR are compatible and subjected to ongoing evaluation and modification by the DUR Board. A system of drug use review that can detect potential adverse drug interaction, therapeutic duplication, drug age conflicts, etc. Therefore drug information to integrate into a DUR system is developed electronically based on the predetermined standards guidelines by commercial vendors of DUR services contracted with State agency. Differences between source materials were resolved by expertise of physicians and pharmacists to come agreement.

This study aimed to measure the patients’ willingness to pay for the Medication Therapy Management Service (MTM). A Contingent Valuation Method (CVM) was used through face-to-face interview for patients who have chronic diseases. The interview was conducted at the three community pharmacies and one hospital in the Metropolitan area from March 8th to April 5th, 2008. The response rate was 33%. Stata 10 was used for the statistical analysis. Fifty-eight percent( 57.58%) of respondents were willing to pay MTM Service provided by pharmacists. Willingness to pay for the MTM Service was 6,000 won for all the respondents, whereas that was 10,420 won for those who would like toreceive this service. Income was a major predictor for the willingness to pay for the MTM services. Willingness to pay for the MTM Service was 10,420 won for those who would like to receive this service. The importance of the MTM Service is to be emphasized for the patients in Korea.