MANAGED CARE November 1998. ©1998 Stezzi Communications
The expense associated with drug misuse is getting a close look from health plans, which are fighting cost battles on two fronts: a double-digit rise in pharmacy expenses and an upturn in medical costs, which have accelerated as utilization reductions have become difficult to sustain. Plans are leaning more on consultant pharmacy and technology for help.
Mississippi received HCFA approval to pay pharmacists for services to Medicaid recipients. Pharmacists will provide education, monitor compliance and manage prescriptions for diabetes and asthma patients.
Pharmacists will be paid $20 a visit. Mississippi is the first state HCFA has approved for such reimbursement, and several other states — fretting about the excessive cost of hospitalization resulting from inappropriate drug therapy — are interested. In Mississippi, that expense approaches about $80 million per year.
John Skhal, Pharm. D., president and CEO of Pharmaceutical Care Network, a Sacramento, Calif.-based pharmacy benefit management company, puts the problem in perspective. "Eighty-five percent of non-trauma-related hospitalizations are due to inappropriate drug therapy," he says.
PCN recently introduced MedIntelligence, a line of software that helps case managers identify medication issues that could result in hospitalization or other unnecessary utilization. Skhal says the program has saved HMOs and independent practice associations $450 per drug-therapy change, not including hospital and physician costs that were avoided.
Similarly, researchers for Merck-Medco, the PBM, reported in the Journal of the American Medical Association Oct. 14 that electronic monitoring can reduce the risk of dangerous drug interactions. In a one-year study of 23,000 people age 65 and up, a computer program flagged 43,000 prescriptions for potential drug interactions and sent warnings to pharmacists. About 6,000 prescriptions were changed.