The prescription drug benefits of private and public payers are administered and managed with increasing frequency by pharmacy benefit management companies (PBMs) and managed care organizations (MCOs). In light of the passage of The Patient Protection and Affordable Care Act (PPACA) and growth in covered populations, managed care pharmacy interventions will likely be employed to administer a growing body of expanded benefits. Abt Associates conducted a review of the literature on 6 managed care pharmacy interventions that we selected in conjunction with the Academy of Managed Care Pharmacy (AMCP), including step therapy, prior authorization (PA), therapeutic interchange, tiered formularies, drug utilization review (DUR), and medication therapy management (MTM). The objectives of the review were to summarize the effects of the selected interventions based on a scan and quality rating of the literature from the past 10 years and to identify those areas in which adequate literature does not exist. We reviewed and rated a total of 62 unique articles, representing studies on tiered formularies (n = 27), PA (n = 9), step therapy (n = 7), therapeutic interchange (n = 5), DUR (n = 4), and MTM (n = 11) interventions (1 study addressed both tiered formulary and step-therapy intervention).
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