In his article, Somsak Chunharas talks about the four stages of the problem-solving cycle which are: Identifying and analyzing the problem, formulating possible solutions, implementing solutions and lastly, monitoring and evaluating.

One of the factors increasing US healthcare costs is the price of prescription drugs. In 2013, the average cost of US prescription drugs per person was $858 (Nelson et. al 2016). I would like to apply these four stages of the problem-solving cycle to the problem of the high cost of medications to the consumer and the solution from the point of view of a pharmacy benefit manager. I will be following the pattern in Chunharas’ discussion under the topic “Types of decisions and types of knowledge”

1. Identifying and analyzing the problem.

During this stage, the decision-makers identify the problem of the high cost of medications. Decision-makers can obtain data from pharmacies within their network. Decision-makers can analyze the data and find out the various components that contribute to the final cost of the medication to the consumer.

2. Formulating possible solutions.

During this stage, decision-makers attempt to find solutions to the problem of the high cost of medications. Researchers will expect that decisions made at this stage will be derived from the data provided from the pharmacies. At this stage, it is important that researchers communicate with decision-makers and help to interpret the data while advising on mandatory costs (for example, regulatory costs) and possible areas of cost savings (for example, alternative drug therapies)

3. Implementing solutions.

During this stage, decision-makers use existing resources to implement the actions needed for the solution they have adopted. This is where the decision-makers can decide to draw up a drug formulary or other medication cost saving programs for the consumer.

4. Monitoring and evaluating.

During this stage, decision-makers must monitor and evaluate their decisions. At this stage, decision-makers will again use data from pharmacies within their network to measure the success of their cost saving programs. I like the way David Garvin talked about reflecting on our decisions in the interview on the importance of learning in organizations. He talked about a practice in the US Army called “after action reviews” which consists of four basic questions which we can use to evaluate the outcome of our decision: What did we set out to do? What actually happened? Why was there a difference? What do we do next time? (i.e what activities do we sustain and what activities do we improve?)

Many organizations have made various efforts to try to reduce the overall cost of medications to the consumer, however I am not sure the decision-making has followed these four stages of the problem-solving cycle. Hopefully, this article would help PBM managers with their quest to solve this mounting problem


1.Chunharas, S. An interactive integrative approach to translating knowledge and building a “learning organization” in health services management. Bulletin of the World Health Organization. August 2006, 84 (8).

2. Why Do Prescription Drug Prices Keep Rising? Nelson Et. al 2016


  1. Excellent report. Could you add something you can do to help, i.e. here are a few places where you can get your RX’s cheaper!
    Needs a bit of your personal touch to it.
    Thanks for the information.

    • Thanks for your comment Howard,
      Depending on the country in which you live, there are a few ways to get cheaper medications. In the United States for example, people who have health insurance may have prescription plans that subsidize the cost of their medications. Generic (non branded) medications are usually cheaper than the brand name equivalents. Sometimes you can get the brand names at a cheaper price than the generic if the brand name manufacturer has coupons. If a person does not have health insurance, I usually advise that they call around to different pharmacies and ask for the cash price of the particular medication they want. The reason is that some pharmacies have a list of medications that they sell for very cheap and this list is different from one pharmacy to another.
      Hope this helps

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