Economic impact of pharmacist-reimbursed drug therapy modification.

OBJECTIVE: To determine (1) the frequency of the different types of drug therapy modification claims paid by a pharmacy benefits manager (PBM), (2) PBM cost savings and return on investment (ROI), and (3) patient savings from pharmacist-reimbursed drug therapy modifications. DESIGN: Cross-sectional, retrospective, descriptive study. SETTING: Midwest United States in 2006. PATIENTS: Not applicable; 767 paid therapeutic interchange service claims from the PBM database were analyzed. INTERVENTION: Descriptive statistics for PBM costs and cost savings to the PBM and to patients were calculated using all prescription fills. MAIN OUTCOME MEASURE: ROI calculated by dividing net savings across all fills by net costs. RESULTS: Claims were paid to pharmacists for drug therapy modifications to allow tablet splitting, drug therapy changes, and switching noncovered drugs. Tablet splitting provided the largest cost savings to the PBM, accounting for slightly more than one-third of the claims and representing more than one-half of the prescription fills. Switching drugs not covered provided the largest cost savings to patients. Overall, the PBM saved a mean of $20.31 per prescription fill, and patients saved $14.76 per prescription fill. Mean overall ROI to the PBM was 3.55. CONCLUSION: Payment for pharmacist interventions can be an economic benefit for both patients and third-party payers. The cost savings for payers likely will dictate the endorsement of pharmacist-reimbursed programs and economic incentives offered to pharmacists and pharmacies.

Comparison of outcomes using 2 delivery models of anticoagulation care.

BACKGROUND: Studies demonstrate the effectiveness of anticoagulation management service (AMS) in providing antithrombotic therapy for eligible patients. We sought to extend this concept by determining whether an interim telephone model (IT) is comparable to our current AMS model at achieving optimal therapeutic outcomes. METHODS: The 36-month trial (24-month study plus 12-month extension) enrolled 192 eligible patients receiving long-term warfarin therapy at a Veterans Affairs hospital. Consenting participants were randomly assigned to either our current face-to-face clinic model (AMS), or our IT model. The primary outcome was the percentage of time individuals' international normalized ratios (INRs) were maintained within their target INR range (2.0-3.0 or 2.5-3.5). Secondary outcomes included the number of adverse events (eg, thromboembolism or hemorrhage) experienced during the study. RESULTS: We found no statistically significant difference between the 2 groups in the percentage of time maintained within INR target range overall (55.1% for AMS; 57.8% for IT; P = .28) nor over the course of the study. There were no statistically significant differences in the rate of thromboembolic or serious bleeding events between IT and AMS participants. Nevertheless, we did note differences related to intensity of anticoagulation. The IT group receiving treatment at a higher intensity (INR, 2.5-3.5) experienced greater anticoagulation control (P = .04) and fewer complications than the AMS group. The IT participants, however, reported a significantly higher rate of minor bleeding events, experienced mainly by those at an INR range of 2.0 to 3.0. CONCLUSION: Our IT model is a viable modification of our AMS model for the management of patients undergoing chronic anticoagulant therapy.

The use of inhaled corticosteroids in adult asthma.

Inhaled corticosteroids modify some but not all features of airway inflammation seen in asthma. ICS remain the most effective class of medications currently available to treat persistent asthma and result in few clinically relevant adverse effects when used in low-moderate doses. ICS activity is enhanced when used in combination with LABA and, to a lesser degree, LTRAs. ICS are well tolerated in adults. Daily doses of ICS may not be required to exceed 200 micrograms of FP equivalents. From an economic standpoint, ICS provide health care savings because of reductions in asthma hospitalization. The impact of early introduction of ICS in the disease course of asthma remains unresolved. The use of ICS in patients whose asthma is mild, with essentially normal lung function, and infrequent symptoms also remains unstudied. For the time being, ICS remain the first line of asthma treatment for adults with persistent disease.