RESULTS THAT MAKE A DIFFERENCE

Working with a pharmacy advocate and disease management vendor on behalf of a large employer with locations across the country, our benefits consulting team was able to impact more than $1 million in medical and pharmacy costs by employing a comprehensive member medication review of high-risk and high-cost plan members.

Reduce medical risk and waste

What's a medication review?

Medication experts work to ensure patients’ medication are effective, affordable and safe while meeting the appropriate standards of care based on their medical condition. The dialogue between patients and pharmacy experts allows for a thorough review of medication use along with condition education on diet, exercise and preventative care. The outcome can be a simple as encouraging patients to move to a less-expensive treatment and as consequential as identifying harmful drug interactions.

Outcomes

• More affordable treatment option
  A patient suffering from chronic acid reflux was prescribed an effective brand-name medication that was subject to the plan’s highest out of-pocket copay and co-insurance, costing the plan and member nearly $10,000 more annually than a lower-cost generic of equal efficacy. After discussions with the patient, a pharmacist consulted with the patient’s physician. The generic alternative was prescribed, and the patient's condition continued to improve, and his out-of-pocket costs were less than $100 a year.
• Adverse drug risks
  Hormone replacement therapy is often used to treat women with menopausal symptoms. However, hormone replacement often is not recommended for patients with a family history of cancer and stroke. After a pharmacy expert discussed the risks of hormone replacement for this patient given her family history, and in discussions with her physician, the treatment was suspended.
• Medication noncompliance
  A patient with chronic conditions was prescribed multiple medications, one of which was a blood thinner to prevent blood clots. As part of a medication review, it was discovered the patient discontinued the blood thinner because of side effects without consulting his physician. The abrupt discontinuation of this medication poses a cardiac risk the patient didn’t understand. Working with the patient’s physician, an alternative medication was prescribed known to have fewer side effects. The patient resumed treatment without incident.

A medication review and disease management program can identify waste and reduce costs using pharmaceutical and patient information. More importantly, it can identify medication risks due to drug interaction and treatment noncompliance and avoid future, costly and unnecessary medical interventions.