Health Plans Save Over $8.5 Million With Pharmacist Interventions in HIV Prescribing

Authors presented results at AMCP 2022 from a holistic HIV program review in which clinical pharmacists interventions saved more than $8.5 million to health plans over 5.5 years.

As part of the program, a pharmacist identified HIV member pharmacy claims and developed the antiretroviral (ARV) report with an actuarial team that used an algorithm to help identify patients would duplicate or unnecessary prescriptions and prioritizes potential drug therapy optimization opportunities. The report assigned a score for each commercially available ARV as well as details regarding a member’s fill patterns.

Managed care pharmacists conducted a retrospective review of successful HIV interventions completed in both the Medicare (2016-2019) and fully insured Commercial and ACA (2016-2021) Florida Blue populations for HIV treatment and pre-exposure prophylaxis (PrEP), noted the authors.

Interventions were broken into 5 categories with 11 subcategories, with some crossover. The number of interventions also exceeded the number of unique members as HIV regimens often warrant changes over time.

The 5 top subcategories were duplicate ingredients, provider (prescriber and/or pharmacy) education, multiple pharmacies & providers, multiple pharmacies, and multiple providers.

“Over 5.5 years of adopting this ARV report to leverage therapeutic optimization opportunities, the pharmacist team’s successful interventions saved over $8.5 million dollars to the health plan,” said authors.

Of the total 476 unique interventions, the most successful were duplicate HIV regimen ($8,106,233.66; 94.8%) and drug waste ($155,736.62; 1.8%).

 “Clinical pharmacists can implement programs to both effectuate cost savings for health plans and improve safety for members when monitoring claims for appropriate drug therapy in the HIV disease space,” concluded authors.

Reference:
Rosario MS, Reese A, Szasz M, Mendez L. HIV antiretroviral therapeutic optimization: an analysis of a health plan's members to streamline regimens and cost avoidance. Poster presented at: AMCP 2022; March 29-April 1, 2022; Chicago, IL.