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.