Health Care

Health plan expands drug cost-control program

December 2, 2014
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A health plan is expanding a program that partners with a network of specially trained pharmacists to reduce drugs costs for its members.

The West Michigan-based health plan launched an enhanced Medication Therapy Management program in 2011 for Medicare members to help control their prescription costs, and is looking to expand the program next year for its commercial population.

Erica Clark, a clinically trained pharmacist and director of clinical pharmacy programs at Priority Health, said the health plan has had a pretty robust MTM program in place for the last four years for the Medicare population.

“We are looking to expand the program early next year to our commercial population, primarily members who are living with chronic illness and take multiple medications,” said Clark. “How the program works today for Medicare members is we utilize our claims data to identify members who could benefit from a variety of different medication therapy management services.”

The optional free program is encouraged for members who are taking multiple medications, have two or more chronic conditions, and have roughly $3,000 or more in annual drug costs, according to Priority Health. The chronic medical conditions qualifying an individual’s participation range from acid reflux, anemia, and asthma, to autoimmune disorders, cancer, and Parkinson’s disease.

Priority Health’s MTM program uses third party vendor OutcomesMTM based in Iowa to contract a network of local pharmacists within a number of chain and independent pharmacies in the region and across the state of Michigan. Currently, the MTM program connects Priority Health members within the Medicare population with participating pharmacists to act as a resource and consultant, ultimately identifying cost savings for the individual.

Several of the services include comprehensive medication review, work with the physician to resolve any problems with prescriptions, identify over-the-counter drugs to treat minor ailments, and information on new medications.

“I would say the heart of the program is the comprehensive medication review, and that is an actual sit-down, face-to-face with your community pharmacist and actually spending 30 minutes to even an hour reviewing all your medications,” said Clark. “It includes things you might take over-the-counter, or samples you might get from your doctor, and looking for things like missing drugs, too many drugs, drug interactions, or medication adherence.”

The program was designed to help members identify potential cost savings and most of the interventions involve pharmacists finding new generic opportunities, which are often 10 times less expensive than brand name medications, according to Clark. In the first year, more than 60 percent of members who participated in the MTM program were able to control their out-of-pocket prescription costs.

“It is usually a patient taking a brand name medication can switch to a generic that treats the same condition, and in the same drug class. In our Medicare population, they have a coverage gap, so cost is really important to them,” said Clark. “The majority of our commercial members have a high deductible plan or some sort of deductible attached to their plan, so they are very cost conscious.”

With increasing drug prices and a stronger adherence rate by members who use cost-effective medications, Clark said the program is one strategy Priority Health is using to improve clinical outcomes and reduce overall health care costs.

Wayne Wilson, vice president of Medicare at Priority Health, said the program is an example of the organization’s commitment to improve the health and lives of the individuals served.

“It not only ensures that all medications are safe and necessary, but it can create savings for our members when a prescription is no longer necessary or a generic alternative is available,” said Wilson.

Priority Health’s MTM pharmacists work with local pharmacies in more than 40 Greater Grand Rapids-area locations and throughout Michigan. Participating pharmacies in Grand Rapids include Family Fare, Meijer, D&W, Rite Aid, Walgreens, Walmart and a number of independent pharmacies.

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