Managed Care and Pharmacotherapy Management

In the last two decades, managed care has become the dominant model for health care delivery in the United States. It is estimated that 70-75% of the U.S. population receive their health care from managed care organizations (MCOs) [1], defined as health maintenance organizations, point of service plans, and preferred provider organizations. Managed care has been especially prevalent in employer-sponsored health insurance, but managed care penetration of government sponsored health benefits also has increased in recent years. Given the prevalence of managed care, it is important to understand its role in the delivery of health care and its impact on pharmacotherapy management. In the first part of this chapter, we describe the managed care model and the types of MCOs. In the second part of the chapter we discuss managed care strategies specifically related to pharmaceutical therapy. We conclude with a discussion of current and future issues related to managed care and pharmacotherapy management.