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Mari Edlin is a frequent contributor to Managed Healthcare Executive. She is based in Sonoma, California.
What works for retail pharmacy patients should work for mail-order recipients, namely, personalized drug counseling. When consumers pick up their prescriptions at a local pharmacy, they have access to pharmacists who can advise them on how and when to take medications, warn them of potential side effects and discuss generic alternatives.
The Lewin Group estimates that mail service pharmacy will account for 21.2% of outpatient prescription drug spending in 2007, or about $43.4 billion, and save more than $85 billion in drug expenditures during the period from 2007 to 2016.
PHARMACISTS AS CARE MANAGERS
"We wanted to provide a higher level of service and develop pharmacists who are experts on specific conditions and the medications used to treat them," says Glen Stettin, MD, senior vice president of clinical and therapeutic solutions for Medco, based in Franklin Lakes, N.J. "The results are less variability in prescription drugs and fewer errors, while also giving pharmacists a mission."
Today, Medco has more than 700 specialized pharmacists trained and certified in specific chronic conditions, such as high blood pressure, high cholesterol, diabetes, cancer and asthma; they staff therapeutic resource centers. Specialists not only receive training in a classroom, but also through roundtable discussions and case studies.
Specialists are on call to answer patient questions about conditions, while also proactively contacting patients if a concern arises when the pharmacist reviews a mail prescription. As many as half of the patients with diabetes served by Medco-1.4 million-take advantage of the therapeutic research center designed for diabetes, and about 45% of the 30 million members with chronic conditions use the opportunity to be evaluated by a specialized pharmacist. Medco dispenses about 90 million prescriptions via mail per year.
With integrated databases that provide real-time prescription medication history and medical diagnoses when available, the specialists can collaborate with physicians and their patients on drug safety issues. They may also consult with physicians to provide patients with the most cost-effective medications. Dr. Stettin also points out that specialists have access to each other and the ability to discuss ideas and concerns as a team.
He describes an incident in which a patient had been prescribed a 50% higher dosage of a chemotherapy drug during the second cycle of treatment. Raising a red flag, the specialized pharmacist called the physician's office to question the prescription, only to be rebuffed by a clinic nurse who confirmed the doctor's order. Not satisfied with that result, the pharmacist called back after consulting with others and found out that the prescription had been miswritten.
Other problems may relate to drug regimens, such as overuse of Beta agonists for uncontrolled asthma, multiple medications prescribed by different doctors and incorrect dosing, especially for cancer drugs, which are based on height and weight of a patient.
"If you only deal with certain medications occasionally, it is difficult to pick up certain problems," Dr. Stettin says, "which is why the specialist model works so well."
Medco also has strengthened its care management capabilities by developing an alliance with Healthways, a disease management company. The two companies share a database so that potential problems don't fall through the cracks.
Last month, Medco announced it is building a new 318,000 square-foot mail-order site in central Indiana.