Diabetes pharmacy management: balancing safety, cost, and outcomes.

Medication nonadherence, clinical inertia, and contradictory clinical evidence on aggressive disease management contribute to poor outcomes in diabetes management, leading to increased healthcare utilization and costs. As plans increase their focus on the management of type 2 diabetes as an area of high healthcare resource utilization, the importance of appropriate antihyperglycemic agent selection is receiving more attention. The selection process is further complicated by the crowded diabetes drug category, which features several agents with diverse mechanisms of action and routes of administration. The choice of specific antihyperglycemic agents should be predicated on their effectiveness in lowering glucose levels, extraglycemic effects that may reduce long-term complications, safety profiles, tolerability, ease of use, and expense. Beyond appropriate drug selection, pharmacy benefit design also represents an important public health tool for improving treatment adherence and outcomes. Value-based benefit design, in particular, emphasizes high-value medical services by lowering patient copays to encourage plan member use. Essentially, this innovative form of benefit design dictates that the more clinically beneficial the therapy, the lower patients' cost share will be. Other interventions, such as motivational interviewing, pay-for-performance, and medication therapy management, are also being applied to improve treatment adherence and outcomes in the managed care environment, with varying levels of success. Regardless of the specific inventions applied at health plans for improving treatment success in type 2 diabetes, pharmacy director leadership and involvement can contribute to the success of these efforts.