Managed care pharmacist outreach can impact opioid use

Pharmacist outreach can decrease drug costs and reduce emergency room visits

November 30, 2017

What was the study about?

Is a managed care pharmacist consultation intervention associated with…

  • Reduced controlled substance (CS) drug costs?
  • Lower emergency room (ER) visits?

Yes.

Managed care pharmacist intervention by a PBM or health plan, conducting outreach to prescribers, was associated with reduced emergency room visits and CS drug costs among persistent CS users.

What did the pharmacists do? What was the intervention?

The pharmacists sent a letter to prescribers. For the recalcitrant members, the pharmacists followed up with the prescribers by telephone. The pharmacists provided information about CS regimens and suggested changes that could potentially improve member safety.

What did we learn?

Over a one-year period, managed care pharmacist to prescriber outreach was associated with fewer ER visits and lower CS drug costs compared to a concurrent control group not receiving the intervention. The drug cost savings for the six-month analysis period translated to an ROI of 4:1.

Methods

The study used retrospective integrated medical and pharmacy claims from 2015 and included a concurrent comparison group.

  • The intervention group was from a ~1 million member commercial plan. It had 213 persistent CS users (CS overuse in two consecutive quarters). Members in the intervention group were prioritized by a dedicated pharmacist, who then contacted prescribers and documented activities. The intervention group was followed for six months.
  • This was compared to a concurrent control group of 1,387 members who were persistent CS users from two different commercial plans with a combined 3.3 million membership who did not receive an intervention.

Results

Pharmacist to prescriber outreach were associated with fewer ER visits and lower CS drug costs among high use controlled substances users. Lower CS drug costs translated to an overall savings of $195,960 over the six-month post period ($0.03 PMPM) with a pharmacist effort (0.75 full time employee [FTE]) cost for a 4:1 return on investment (ROI). This ROI takes into account the difference in costs compared to the concurrent control group.

The study shows a good ROI using a managed care pharmacist to contact prescribers by phone or fax for members whose CS claims appear to indicate high abuse potential. The prescriber telephone calls are only for the small number of recalcitrant members.

The incremental $920 CS savings per member intervention translates to $195,960 ($920 x 213 members), for the six-month analysis period, for an ROI of 4:1.

What does this mean for you?

Prime’s Controlled Substance Management Program includes several types of outreach to pharmacists and prescribers. These may be thought of as an expensive form of intervention (compared to member outreach by letter or benefit design edits). But they identify and target members at high risk with great precision. Professional outreach by a managed care pharmacist builds plan sponsor/prescriber relationships.

Impact of a Managed Care Pharmacist Consultation Program on Controlled Substance Drug Cost, Emergency Room Visits, and Hospitalizations. April 2017.

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