Bending the Cost Curve through Pharmacy

By Devin Stone

A comprehensive new study offers a pair of critical lessons for medication therapy. First, community pharmacists are highly trained medication experts that can help patients optimize the value of their medications, while saving money. And, second, the tangible value of such interventions plummets when delivered by distant pharmacists outside of the patient’s local community. 

Pharmacists work with physicians and patients to adjust medication regimens to boost adherence while minimizing the potential for adverse drug events.  Such quality management of medications can lead to lower health care costs by reducing the chances of more costly forms of care such as hospitalizations and emergency room visits. 

The gold standard in demonstrating the role that pharmacists can play in promoting better health through patient-centered care have been the original Asheville studies beginning from 1996, with new research projects occurring ever since.

A recent study published in the Journal of the American Pharmacists Association, demonstrated that MTM interventions performed by community pharmacists were able to reduce prescription drug costs on average by $35 per month, providing annual savings of $420 per patient.

The study was conducted by the Mirixa Corporation, created by NCPA in 2006 to help pharmacists better provide medication therapy management (MTM) programs for their patients.  Mirixa has been a success, as already pharmacists using the MirixaPro Platform have performed interventions for over half a million patients.  Even more amazing are the quantified savings that have occurred from these MTM interventions. 

These pharmacists were able to help patients reduce their prescription drug costs by working with physicians and patients to end duplicative therapies, promote the use of less expensive generic drugs, and make other changes to the patient’s medication regimen for safety and cost reasons. 

The study is limited in that it only compares changes in prescription drug spending due to MTM programs, even through previous studies have demonstrated that MTM programs not only improve the health of patients but can also help to lower non-drug medical expenses. 

It is important to note that not all MTM programs are equal.  Although it is financially cheaper for pharmacy benefit managers (PBMs) to do a mass educational mailing to their covered lives, such a practice is less effective.  As the authors of the Mirixa study note,

“Educational mailings do not meet the profession wide definition of MTM.  Although an educational mailing met Centers for Medicare & Medicaid Services requirements for an MTM service in 2007, results from the current work suggest that it is not effective at improving patient medication use.”

Many PBMs are promoting the use of pharmacists specialized in specific disease states that can perform MTM over the phone and through educational mailings to at-risk patients.  Despite many of these PBM led initiatives, the Mirixa study demonstrates that interventions performed by pharmacists through call centers are only half as effective in creating prescription drug savings as interventions performed by community pharmacists via telephone or in person.  Educational mailings were the least effective leading to average monthly prescription drug savings of $1 per patient per month. 

The disparities in the potential for savings should cause alarm for health plans that are mandating and/or incentivizing their patients to use a mail order pharmacy.  Community pharmacists are health care professionals that provide a service that is of value to their patients.  Mandating that a patient abandon that relationship in order to receive their prescriptions from a pharmacy owned by the PBM stifles competition to the detriment of patients and health plans.  Freedom of the patient to choose their preferred pharmacy must be preserved so that these patients can continue to use the pharmacy that best meets their individual circumstances, so that patients can make the most of their medications.

7 Responses to “Bending the Cost Curve through Pharmacy”

  1. 1 Jon December 18, 2009 at 8:20 pm

    It makes sense that a face-to-face encounter would be more thorough and allow a patient to make the best decision for their health in conjunction with their healthcare provider. It also makes me wonder if there is a conflict of interest for pharmacists employed by a PBM. Independent pharmacists might be more concerned about esnuring the best therapy while saving money for their patient, while a pharmacist working for a PBM might be protecting the best interest of the PBM: trying to fill prescriptions with the highest profit margins in the largest numbers. Perhaps thats another argument for community-based face-to-face MTM.

  2. 2 stanley December 31, 2009 at 9:04 pm

    Most independents are small one pharmacist stores who are doing all they can do just to fill the prescription volume each day. I am one of those. How am I suppose to find the time to add MTM to my day? I understand that is where the industry is heading but could someone please explain how I am suppose to add this to an already hectic day?

  3. 3 Editor’s note January 7, 2010 at 3:01 pm

    We hear you. Certainly, every pharmacy’s different and each owner needs to decide what works best for their pharmacy. Our latest research indicates that more independents are scheduling patient appointments to provide MTM and other services. There are applications available that may help, such as Mirixa.

  4. 4 David March 6, 2010 at 4:33 am

    I too feel the same way about trying to fit MTM into a hectic independent pharmacy day at a one-man pharmacy. Its stressful to try and figure out where to fit it. The apps provided by Mirixa and Outcomes definitely help, but arent the panacea for pharmacists like us.

    Its also surprising that some big chains are not embracing MTM, leaving more opps/demands for us independent practitioners.

  5. 5 Mike March 30, 2011 at 7:11 pm

    I used to run a newtork of pharmacist MTM providers (’till we had to shut it down in 2006 for lack of demand for MTM). Back then we we were looking to set up a “group practice” model, where a particular MTM pharmacist would contract to develop/provide MTM services with 5-10 different pharmacies. The idea was to have this pharmacist start out by providing scheduled MTM services at each pharmacy 1/2-1 day/week. As volume would build, we’d add other contractors, and/or work to cross train existing pharmacy staff. Too bad we weren’t able to really to test the model before shutting down the company.

  1. 1 Commoditizing Pharmacy, Commoditizing Adherence « NCPA's The Dose – The Voice of the Community Pharmacist Trackback on April 30, 2010 at 3:53 pm
  2. 2 PBM Studies: Reliably Unreliable « NCPA's The Dose – The Voice of the Community Pharmacist Trackback on May 25, 2010 at 6:10 pm

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