Insights with Impact: Pharmacist interventions

Two research studies from Prime Therapeutics (Prime) won gold medals from the Academy of Managed Care Pharmacy (AMCP) in March 2017. Both studied the effects of pharmacist interventions on specific high-risk populations.

Prime has always understood this critical role
“These studies demonstrate the positive impact pharmacists can have at many points along the health care continuum,” said Pat Gleason, Senior Director of Health Outcomes at Prime. “Pharmacists can provide so much more than just service at the corner drug store.”

The studies put the role of the pharmacist at the center of the intervention. In both studies, pharmacists worked with a pharmacy benefit manager or health plan as part of the health care team.

America’s nearly 300,000+ pharmacists1 are a proactive part of American health care. They are often an important point of engagement between members and their doctors. Their specialized training in medications and medication management make any outreach conducted by pharmacists grounded in credibility.

Pharmacists have a combined understanding of the:

Health care system
Concerns of people with chronic conditions requiring complex medicines
And those 300,000 pharmacists? They don’t all work in drugstores.

Outreach to high risk members with chronic conditions
The first study involved managed care pharmacists who reviewed claims from a Blue Plan’s commercial and Medicare members. The pharmacists identified members with chronic conditions who could benefit from medication therapy management (MTM).

As members were identified as “high-risk,” outreach was conducted to the members and their providers
The unique knowledge base of the pharmacists — combined with a front-line understanding of new drug therapies — allowed for medication therapy optimization recommendations for many different chronic conditions
$8.6 million in cost savings identified, actuarially validated
Outreach to providers regarding controlled substances
In the second study, Prime, in collaboration with the Blue plan, added a pharmacist consultation program designed to reduce the use of controlled substances (CS).

A managed care pharmacist intervention with the provider was associated with $920 lower controlled substances costs per member
The incremental $920 CS savings per member intervened upon translates into $195,960 in savings
The studies won gold. The results were associated with improved outcomes and saved money. These were just two of nine Prime studies published by AMCP in March 2017.

Result #1: The first outreach program showed $8.6 million in actuarial validated savings — a conservative 10:1 return on investment (ROI) with an estimated administrative cost of $780,000 for five managed care pharmacists.

Result #2: For the second study, the CS outreach pilot, the lower CS drug costs translated to an overall savings of $195,960 over the six month post period ($0.03 PMPM) with a $50,000 pharmacist effort (0.75 FTE) cost for a 3.9 return on investment (ROI).

The difference between a cost and an investment
Prime’s research team turns medical and pharmacy claims data into true insights — free from bias and industry agendas. These studies are further proof Prime develops programs grounded in research that demonstrate repeatable outcomes.

Working with our Blue Plan partners, Prime is committed to designing solutions that both improve health outcomes and control health care costs.

Follow our Insights with Impact series in Prime’s newsroom.
1. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2016-17 Edition, Pharmacists, on the Internet at https://www.bls.gov/ooh/healthcare/pharmacists.htm (visited April 05, 2017).