Impact of a Patient-Centered Pharmacy Program

BACKGROUND: The medication therapy management (MTM) program identified high-risk members in a large employer group and invited them to participate in an MTM program. The intervention consisted of at least 3 consultations with a clinical pharmacist to review and discuss drug therapy. The goal was to improve drug therapy adherence and clinical outcomes. OBJECTIVE: To assess the impact of MTM on plan-paid health care costs, utilization of medical services, overall days supply of targeted medications, and medication possession ratios (MPRs). METHODS: The MTM and control group comprised eligible members of a large employer prescription benefit plan who were identified between October 1, 2007, and November 12, 2008, and invited to participate. Control group members were selected from targeted members who declined. After propensity score matching to ensure similarity of groups at baseline, each group had 2,250 members. Baseline comparisons and post-period impact analyses between groups were conducted using bivariate analysis. Postperiod analyses used tests for paired comparisons. The MTM and control group members were studied for the year before and after their individual program invitations. We measured pre-post differences between the MTM members and controls in total heath care costs, inpatient visits, emergency room (ER) visits, total days supply, and MPRs for 5 conditions: diabetes, hypertension, dyslipidemia, depression, and asthma. RESULTS: MTM members significantly reduced their plan-paid health care costs by 10.3% or $977, compared with an increase of 0.7% or $62 in the control group (P = 0.048). Inpatient visits in the MTM group decreased by 18.6%, while the control group experienced an increase of 24.2% (P < 0.001). While both groups had decreases in ER visits, the groups were not significantly different (P = 0.399). Average days supply for the MTM group increased by 72.7 days over baseline; for the control group, it decreased by 111.1 days (P < 0.001). MTM members with hypertension and dyslipidemia had pre-post increases in MPR of 2.29% and 2.10%, respectively, while the control group had decreases of 2.31% and 2.61% (both P < 0.001). The mean MPRs for members with diabetes, depression, and asthma did not change in either group. Program costs per patient in 2009 were estimated to be $478. The program had a return on investment (ROI) of 2.0 in 2009. CONCLUSIONS: This study found that the pharmacist-managed MTM program to reconcile the medication therapies of high-risk patients and improve adherence, as measured by MPR, was effective in reducing total health care costs. The results show that those patients in the intervention group with hypertension and dyslipidemia had significant improvements in medication adherence, as compared with the control group. In fact, the intervention group used significantly more days of therapy in the intervention period, and the control group used significantly fewer days than either group used during the baseline period. MTM interventions were associated with a significant decrease in the MTM members’ overall plan-paid health care costs, driven largely by decreases in inpatient utilization and mediated by increases in average days supply and in MPR increases for hypertension RESEARCH and dyslipidemia. Overall, the MTM program was cost-effective. The ROI estimated for this program of 2.0 is only slightly lower than the average disease management ROIs reported in the literature. J Manag Care Pharm. 2013;19(3):228-36 Copyright © 2013, Academy of Managed Care Pharmacy. All rights reserved. • A recent summary of the literature on the effectiveness of medication therapy management (MTM) programs included only 11 studies; small sample sizes and research design issues were identified as problems. It found that MTM programs were often associated with clinical improvements, but studies on utilization of medical services and medications were mixed. The review noted in particular that there have been few published studies conducted by pharmacy benefit managers (PBMs) or Medicare Part D programs and that few studies report program costs along with program savings. • One PBM MTM study reported on the effectiveness of an intervention in which a letter about statin initiation was sent to the prescribers of patients with diabetes or coronary artery disease. With an intervention group of 1,144 members and a control group of 700, the study found a highly significant improvement in statin initiation rates for the intervention group. • Several highly focused pharmacist-managed programs for specific disease conditions or medications have reported significant improvements over the current standard of care. For example, a retrospective study of pharmacist-provided MTM services to Medi-Cal patients with human immunodeficiency virus or acquired immune deficiency syndrome had a large study population, with 1,353 patients receiving interventions and 5,665 control group patients. This study reported a highly significant impact on adherence. What is already known about this subject • This retrospective PBM study evaluated 1 of the largest MTM programs reported in the literature, with 2,250 patients receiving interventions matched to 2,250 patients without interventions through propensity score matching. • The intervention group had an average post-period reduction in total health care plan-paid costs of $977, compared with the control group’s increase of $62 (P = 0.048). What this study adds