Objective: To evaluate the prevalence of various pharmaceutical cost manage
ment strategies used by group practice, within a managed care network and t
heir relationship to drug costs among enrollees.
Strategies Studied: Care management (gatekeeping, practice profiling, pract
ice guidelines, case management), techniques for maintaining clinic medicat
ion records, and policies regulating physician interaction with pharmaceuti
cal sales representatives (PSRs).
Study Design: Cross-sectional survey of primary care group practice organiz
ations (n = 103) affiliated with Blue Cross Blue Shield of Minnesota in ear
Methods: Multivariate linear regression analysis was performed on correspon
ding claims data for members continuously enrolled in these practices from
January 1 to December 31, 1995 (n = 76,387), using the patient as the unit
Results: Substantial variation in strategy prevalence was observed; this va
riation was thought to influence pharmaceutical costs. Seventy-six percent
of practices had medication lists in outpatient medical records, 53% had po
licies limiting pharmaceutical detailing, and 44% had patients assigned to
primary care gatekeepers; however, only 10% used outpatient nurse case mana
gers. Use of outpatient nurse case managers (P < .010), primary care physic
ian gatekeeping (P < .002), policies to control pharmaceutical detailing (P
< .001), and medication lists and outpatient charts (P < .001) was found t
o be independently associated with lower pharmaceutical expenditures. Signi
ficant colinearity was found between group size and the strategies studied.
Conclusions: Significantly lower pharmaceutical costs per member per year w
ere observed in the groups reporting primary care gatekeeping, outpatient m
edication records, outpatient case managers, and policies regarding physici
an interactions with PSRs.