As more and more Americans are developing chronic conditions such as arthritis, coronary heart disease, diabetes and hypertension, demands on the U.S. health care system are ever increasing. Over 133 million Americans suffer from at least one chronic disease.1 An uncontrolled disease state can bring about serious health and financial complications. Between physician shortages and many individuals not having easy access to doctors’ offices, however, gaps in care are becoming more and more common.
Pharmacists can close these gaps in care and plan sponsors can and should leverage pharmacists as much as possible in order to improve the health of their members.
According to a report from the Centers for Disease Control and Prevention, over one-third of adults in the U.S. aged 60-79 use five or more prescription drugs. Using multiple medications puts patients at an increased risk for negative interactions between prescriptions, which can lead to side effects such as cognitive decline and possible hospital stays. In fact, the Institute of Medicine reports that more than 1.5 million preventable adverse drug events occur annually in the U.S.2
Furthermore, multiple medications can be expensive and hard for the individual taking the medications to manage on their own. Members with chronic conditions often have substantial prescription drug expenses. The cost of diabetes medication, for example, has skyrocketed in recent years.3
Multi-prescription use is not only a trait of the elderly. Approximately one half of young adults aged 18-34 have at least one chronic condition, with 22% having more than one.
Each member has different health concerns, medication needs, allergies, etc., but not every member can have their needs easily met. Due to time constraints during doctor appointments, physicians rarely perform comprehensive medication reviews. Pharmacists, however, are already the medication experts and have the ability to reduce gaps in care by conducting these reviews.
A CMR consists of a real-time interactive consultation, either in person or on the phone, between a health care provider, such as a pharmacist, and a member to review their entire medication profile – inclusive of prescription and non-prescription drugs, herbal products and nutritional supplements. Pharmacists review timing of taking each medication, what medications are taken together, etc. and can utilize this to educate the individual on potential adverse events from a medication – especially those with a heightened risk of causing significant harm, such as insulin or inhalers. Not only this, but pharmacists can also discover cost saving opportunities.
While plan sponsors may assume CMRs are just for members in Medicare drug plans, they can be adopted for commercial and public sector plans as well. Plan sponsors can implement CMRs by setting up the criteria for member qualifications into the program based on the number of chronic diseases they have and medication they take. Comprehensive medication reviews create an average of $4,000 in medical expenses reduction per patient per year.4
Medication non-adherence is costly for not only members, but plan sponsors as well, as this can lead to higher medical costs and lost productivity as members take time off to manage their health. Plan sponsors can and should leverage pharmacists to improve care and drive value for their members. Offering CMRs as part of their PBM can help sponsors educate and engage members with the highest annual drug spend.
A large health plan covering both individual and family benefits implemented our CMR program, setting a goal to complete comprehensive medication reviews for 30% of their qualified population. Within two months, the health plan outperformed that 30% goal, and saw close to a 50% CMR completion rate. Furthermore, out of the members outreached, over 80% agreed to have a conversation with a pharmacist.
4 Results from 2019 yearlong case study conducted by health plan, which serves more than 300,000 members