What does a targeted review involve and why do it?
Our service involves reviewing prescription drug claims according to pre-determined criteria to identify patients having a high probability of suboptimal drug therapy due to patterns of high drug use, high cost, or use of drugs with a high risk potential. We always do so in a manner that masks patient identity or preserves patient confidentiality. It is usually the case that a relatively small number of patients account for the highest use of services and are the costliest to the health plan. When examined more closely, we often find opportunities to simplify drug regimens or to use lower cost medications.
Targeting patients in this manner is the most cost-effective way to provide savings to payer and the patient. A required service under Medicare Part D, we believe the same process can benefit patients less than 65 years of age.
How is the review conducted?
Once our drug use review service identifies cases for possible follow-up, a Comprehensive Medication Review Service that involves having a qualified pharmacist review the patient case is offered. Many times the patient’s regular pharmacist can provide this service. If not, we refer the case to an in-state drug therapy expert.
The service is voluntary. First, the pharmacist contacts the patient and, with permission, conducts either a phone interview or face-to-face meeting to gather data about all current medications including OTCs, herbals and vitamin supplements, and the reasons for taking them. Next, the pharmacist reviews the list for potential drug therapy problems or opportunities to decrease costs, and contacts the patient’s doctor with recommendations. The pharmacist then follows up with the patient and the dispensing pharmacy (if different).
Many times patients don’t fully understand their disease or how drug therapy works for them. We often find that the most effective interventions involve explaining drug therapy to patients to encourage better drug taking compliance, and teaching or reinforcing self-management and self-monitoring skills.
What are the benefits?
Studies show that service initiated changes in drug therapy reduce drug and/or medical care costs.
Secondly, patients are usually highly satisfied with the service, especially when they feel there is insufficient time to fully discuss these matters with their regular physician or pharmacist.