Support grows in medical community for larger health role by pharmacists
WHAT IT MEANS AND WHY IT’S IMPORTANT Community pharmacists are lining up powerful professional allies as they fight for a full seat at the health provider table and fair payment for the critically needed patient-care services they can provide.
(THE NEWS: JAMA article points to pharmacy’s role in MTM, improved patient care system.For the full story, click here)
In just the past few days, two prestigious medical journals and the highly regarded New England Healthcare Institute have issued reports calling attention to the prominent role that retail pharmacists can play in a more effective, cost-efficient and patient-centered healthcare system. And the contributions they can make in disease and medication therapy management and in patient adherence, the reports noted, are best realized when pharmacists are working in collaboration with a team of patient-care professionals.
That means working in close partnership with family-care physicians, specialists, nurses, nurse practitioners and health-plan sponsors, the reports agreed.
Measured against the old pharmacist-doctor turf battles of recent decades, the change in tone is striking. Much of the last century of American medical practice has been dominated by a climate of professional stake-holding, with many doctors fiercely guarding what they considered a unique and inviolable relationship with the patient. Pharmacists, many physicians asserted, simply were not qualified to dispense anything much beyond medications and basic counseling on their use, and had no business inserting themselves in that finely calibrated regimen of care developed between doctor and patient.
How times have changed. There still may be lingering suspicion of pharmacy’s aims and abilities among a diminishing number of family practice doctors — along with a few lingering questions of professional turf and responsibility. But most primary care physicians are in dire straits, swamped by rising case overloads, third-party billing headaches and the enormous demands of a fast-changing health system in the throes of an information technology revolution. They’re only too happy to have community pharmacists, nurse practitioners and other patient-intervention professionals as allies.
That’s particularly true in light of the growing body of evidence demonstrating just how much community pharmacists and nurse practitioners can bring to help doctors manage their caseloads, especially if working in a collaborative, team approach with shared patient data. As the Journal of the American Medical Association made clear in an article published Oct. 13, pharmacists and nurses can help close the loop for a fully integrated link with patients and create a more “cohesive” network of care.
Indeed, wrote Jerry Avorn in JAMA, “pharmacists and nurses could work with physicians to develop, implement and monitor drug regimens.”
The Archives of Internal Medicine went even further. Pharmacists, Archives author B. Joseph Guglielmo noted, can play a “valuable role … in chronic disease management in outpatient clinic settings.” But they’ll never be able to fully deliver on that promise without fundamental structural changes to the health delivery system — and a fair system of reimbursement for their clinical and medication therapy management services.
Teva markets generic Mirapex
NORTH WALES, Pa. Drug maker Teva Pharmaceuticals has launched a generic treatment for Parkinson’s disease, Teva said.
The company announced the launch of pramipexole dihydrochloride tablets in the 0.75-mg strength.
The drug is a generic version of Boehringer Ingelheim’s Mirapex. Teva already offered the drug in the 0.125-mg, 0.25-mg, 0.5-mg, 0.75-mg, 1-mg and 1.5-mg strengths.
CVS Caremark highlights ways clients can save money, improve generic dispensing rates in three new studies
WOONSOCKET, R.I. CVS Caremark is presenting data at the Academy of Managed Care Pharmacy 2010 Educational Conference illustrating how innovative approaches to traditional plan designs can help clients reduce drug spend, improve generic dispensing rates and minimize member disruption.
The AMCP 2010 Educational Conference is being held in St. Louis from Oct. 13 to 15.
"[Pharmacy benefit managers] have a variety of tools available to help clients reduce costs and increase GDR; however, because these approaches may require a change in member behavior and can be disruptive to the member experience, clients may hesitate to fully implement these plan designs," stated Per Lofberg, head of CVS Caremark’s PBM business. "Our research shows that by adapting these traditional plan design elements to provide members with appealing options, increased flexibility and proactive communications, we can minimize member disruption and increase the savings opportunity for clients."
During the conference, the company is sharing results from three different client experiences that demonstrate how by adapting such traditional plan design approaches as step therapy and 90-day prescription mail pricing, plan sponsors see improved results while members experience minimal disruption.
One of the CVS Caremark studies reviewed a new approach to driving a generics-first strategy focused on proton-pump inhibitors. This class of drugs reflected a significant pharmacy spend for an employer client, and the clients’ goals were to reduce prescription spend in this drug class, without compromising access or member satisfaction. Rather than implementing a traditional plan design in which drugs in the class would be shifted to a higher tier or the member cost-share would be increased, the client opted to provide members with first-line access to generic options and a preferred brand, which was due to become available as a generic (lansoprazole) within six months of implementation. In addition, members received the CVS Caremark ExtraCare health card, a pharmacy discount card that provided them with a 20% discount on FSA-eligible store brands to help manage the costs of over-the-counter alternatives. Members and their prescribing physicians also received proactive communications about the new plan design three months prior to implementation.
Results showed that the proactive communications outreach significantly decreased potential member disruption, with 56% of eligible members converting from a nonpreferred brand to an alternative therapy in the first four months of the program before experiencing a rejected claim. In addition, one year after program implementation, the client experienced a 20% reduction in PPI spend, and the client’s GDR in the PPI class of drugs increased from 53.7% (one month prior to implementation) to 75.6% in the first month and remained steady in the five subsequent months.
Asecond study examined the impact of a step therapy program designed to address concerns about potential member disruption, which is common when implementing step therapy where members are required to use preferred brand or generic drugs before nonpreferred drugs. Prior to implementation, three phases of proactive communication and outreach were conducted:
- The plan sponsor sent notification letters about the upcoming plan design change to members and physicians 60 and 30 days prior to implementation;
- A dedicated call center handled questions and prior authorization requests; and
- Physicians were able to proactively request prior authorization through the call center prior to implementation of the new plan design.
After program implementation, the average gross cost per claim for the 10 selected classes resulted in savings of 12.8%, and the GDR rose from 57.5% to 72.8% after one year of the program. Furthermore, the client reported no escalated member complaints.
Athird study highlighted the reduction in overall drug spend that can be achieved by implementing Maintenance Choice, a plan design that provides members with options for how they can receive their 90-day maintenance prescriptions in a mandatory mail plan design. The plan design allowed the client — a health plan ASO employer group that manages 18,000 lives — to move from a voluntary mail plan to a mandatory mail plan that also provided members with the option to receive their 90-day maintenance prescriptions either through mail order or at one of the more than 7,100 CVS/pharmacy locations nationwide for the typically lower mail co-pay and cost. The study analyzed the group’s cost and utilization for 15 months before and after the implementation of Maintenance Choice to assess financial impacts, as well as changes in GDR. Results found that in the 15 months after moving from voluntary mail to Maintenance Choice, the client achieved a savings of 5.7% in average gross cost per day with 82% of eligible maintenance utilization (as measured by days supply) being dispensed at 90-day mail pricing. In addition the client’s GDR increased from 59% to 68% as the result of combining Maintenance Choice with other plan design changes to drive generic utilization.