LACDMH took a big step to further upgrade pharmacy services, increasing the number of pharmacies in our network from 81 to 1,700. More pharmacies mean easier access to prescription medication for the tens of thousands of LACDMH clients that use county-funded services.

How did we do this? On Tuesday, Jan. 17, the Board of Supervisors approved a county contract with Magellan, a Pharmacy Benefits Manager (PBM), an organization that specializes in behavioral health needs. PBMs, currently providing services to over 250 million Americans, are companies— third party administrators—that use information technology, purchasing power and quality management algorithms to allow contracting private and public health programs like LACDMH to improve the quality and efficiency of their prescription operations.

Magellan has the ability to ensure that LACDMH gets the medications that clients need at the lowest possible prices, and that clients can fill their prescriptions within a few miles of any LACDMH clinic or wherever they live. Magellan also has tools that allow clinicians and administrators to measure quality of prescribing. Magellan’s information systems integrate smoothly with LACDMH’s electronic health record.

PBMs operate by making prescribing fully electronic, allowing detailed tracking of formulary use. It uses sophisticated technology to route electronic prescriptions, develop and maintain drug formularies, negotiate prices with drug manufacturers and process and pay bills from pharmacies for dispensed drugs.

Of course, quality prescribing is about something far more important that electronic bells and whistles and low prices. At LACDMH, we recognize that the very core of good prescribing is a relationship between prescriber and patient that is built upon collaboration and trust. It means that a thorough and careful assessment has been completed and all options for care have been discussed in a way that the patient can fully understand. It means that the prescriber has ensured that the patient knows what the medication is supposed to do and what the side effects might be. It means the judgment about whether benefits outweigh risks is based on an understanding of the patient’s wishes and values and that family, when involved in care, has also been included. It means the prescriber has access to proper past medical records and consultation. And it means timely follow up and re-evaluation.

Quality prescribing also means that physicians and nurse practitioners in our system are highly trained, with access to educational opportunities to learn about results of the latest medication research. It means that LACDMH ensures that the medications available to our clients include all those that are necessary for good mental health care treatment. And it means that the limits of medication are respected and that all LACDMH clinicians recognize that medication is no substitute for other effective interventions.

The PBM will move LACDMH firmly into twenty-first century prescribing. We’ll use it to improve convenience, quality and cost. But we’ll also ensure that the timeless values of respect, collaboration and recovery continue to guide care in our system.