Integration of a Clinical Pharmacist Reduces Managed Care Plan Costs

According to an award-winning poster presented at the AMCP 2017 Annual Meeting, integration of a clinical pharmacist into a managed care plan helped to significantly reduce both medical and pharmacy costs by optimizing drug utilization. 

“Pharmacists in a managed care setting can assess both medical and pharmacy claims data to identify drug therapy optimization opportunities; for example, therapeutic switches, dosage/duration optimization, as well as over and under prescribing,” Maryam Khazraee, PharmD, a clinical pharmacist at Prime Therapeutics and Florida Blue Cross Blue Shield, and colleagues wrote. “A managed care health system usually has the data needed to conduct drug therapy optimization interventions. However, dedicated pharmacy resources, outcome measurement, and actuarial validation are often lacking.”

In their study, entitled “Thinking Outside the Bottle: How A Clinical Pharmacist Team Adds Value and Saves Money in a Managed Care Plan,” the researchers studied the efficacy of a drug therapy optimization program that included integrating a pharmacist into the managed care team. 

In the program, five pharmacists were integrated into managed care teams where they used claims data to identify high-risk patients and directly intervene with members and providers. They identified high-risk members as those with high utilization of specialty and other high costs medications. Pharmacists worked with PBMs, medical directors, and health plan case managers to identify therapy optimization opportunities.

Between January 2016 and November 2016, the integrated pharmacists conducted 1307 direct patient interactions that resulted in $8.6 million in validated cost savings. Results showed that pharmacists were able to evaluate 1009 Medicare members and 1385 commercial members over the study period. The researchers found that the return on investment for the pharmacist integration program was 10:1. They noted that the majority of cost savings were the result of therapeutic interchanges in specialty medications.

Dr Khazraee and colleagues concluded that their findings offer “a new attestation for the value of pharmacists to the health care system and can support the need to include innovative pharmacist services into the total benefit. This study demonstrates how appropriate medication use, drug therapy management, and member/provider coordination by pharmacists can result in lower total health care costs.”

This study was conducted with funding from Florida Blue and Prime Therapeutics. —David Costill