Premera Blue Cross asks patients to brown bag it

NATIONAL REPORTS-At Premera Blue Cross of Washington state, a simple brown bag might hold the solution to avoiding adverse drug reactions for patients taking multiple medications.

Premera Blue Cross mails a brown bag labeled "Promoting a health partnership between you and your physician" to a carefully targeted list of members over the age of 18 who take five or more maintenance medications on a daily basis. Instructions come with the bag, and patients are asked to fill it with their vitamin and herbal supplements, in addition to their prescription and over-the-counter drugs, and take the bag to their doctor for review. Doctors then might need to make medication changes, including discontinuing medications, adjusting dosages or adding new medications.

In M arch 2001, Premera analyzed its pharmacy claims data and discovered that about 21,000 of its members over the age of 45 were taking five or more maintenance drugs at once for chronic conditions. Premera's "Polypharmacy" program began in June 2001.

The Premera program is a combination of sophistication and simplicity, according to Wong. "With the advantage of having member pharmacy claims information, Premera was able to develop mailing lists to deliver a simple brown paper bag to these members. This program brings an intervention to the most-effective point in the healthcare system-a conversation between patients and their providers," he says. To date, 56,000 Polypharmacy brochures and brown bags have been mailed.

The Polypharmacy program is a joint effort by the Washington State Medical Assn. (WSMA), Department of Health and Premera. The original brown-bag concept was developed by WSMA in 1993. The "MedCheck" brown-bag program started as an educational program jointly sponsored by the WSMA's Patient Awareness and Community Education (PACE) program and the Northwest Area 10 Office of AARP. In that program, bags were offered to providers, who then gave them to their patients.

"The program encouraged physicians and older patients-or their families/adult caregivers-to work as partners to ensure prescription and non-prescription medications are regularly reviewed," according to Jennifer Lawrence Hanscom, WSMA director of communications and membership.

"Over time, especially when the alternative care movement really took off, we began to encourage our members to use the MedCheck program with all of their patients," Lawrence Hanscom says. "This allowed doctors to keep track of all medications-prescription or non-prescription-and they could make sure that they wouldn't react against each other.

"We also believed the MedCheck program could help to reduce any adverse reaction that may occur when taking several prescriptions," she adds.