ABSTRACT
This chapter explores the concepts and opportunities for pharmacists to practice in managed care. It addresses the various roles and functions pharmacists play in managed care. Managed care encompasses a range of programs, organizational structures, and financial incentives designed to better integrate health insurance and healthcare delivery to more effectively "manage" the delivery of healthcare to patients. Managed care pharmacy focuses on managing medication specific outcomes in a way that drives down the total cost of care and improves the overall well-being of the patient. Disease management is the concept of reducing healthcare costs and improving quality of life for individuals with chronic conditions by preventing or minimizing the effects of the disease through integrated care. A Health Maintenance Organization provides, offers, or arranges for coverage of designated health services needed by members for a fixed, prepaid premium. Pharmacy benefit managers are companies that administer drug benefit programs for employers and health insurance carriers.
