Managed Care - May 2008 - (Page 44) they need to remain at optimum health. Recognizing these facts, one West Coast MCO charged its PBM with finding ways to improve the safety of its elderly patients. Studies indicate that up to 30 percent of hospital admissions in the elderly are linked to medication toxicity and other drugrelated problems, resulting in profound health, safety, and economic consequences for them and their families. This costs the average MCO millions. In recent years, guidelines that are based on expert consensus panels (e.g., Beers Criteria) have been developed to improve prescribing in elderly patients, which may lead to reduced risk of adverse drug events and to a decrease in their associated health care costs. Under the program developed by the PBM, a mailing to providers included an explanation of the program and reports about patients who were taking drugs that might be inappropriate for the elderly. More than 1.3 million seniors were screened for to the identification criteria for inappropriate drugs and pharmacy claims analysis will be used as the sole measure of any changes in prescribing patterns. This same MCO also wanted to create programs to address the misuse of narcotics. Its narcotic drug utilization review program attempts to minimize the occurrence of drug abuse and misuse that may result in serious adverse drug events. Recognizing that patients who have been prescribed a painkiller in this class of drugs need monitoring and treatment, the MCO worked with its PBM to design a program that keeps the doctor at the center of patient care. The PBM gave physicians patient-specific reports of recent prescription claims information for opioid analgesics and gave them current clinical guidelines and policies for the use of these drugs. Armed with this information, the doctor had a more complete picture of potential risk and could act to prevent duplicate therapy to reduce the potential for drug abuse, Potential customers should consult with the PBM’s current and past customers to determine its reputation for integrity. the Geriatric RxMonitor Program. Within this group, more than 1 in 10 (12.7 percent) were found to have at least one prescription claim for drugs to be avoided in the elderly (DAE). The program was successful in resolving the DAE situations for 65.7 percent of the approximately 70,000 members in the program who were taking these drugs. Among members targeted for the intervention, the number of DAE prescriptions dropped by 57 percent postintervention — from 126,227 to 53,772. In addition, DAE prescription costs fell 50 percent as a result of fills avoided (from $11.15 to $5.60 per targeted member per month). The PBM and MCO noted that two factors may have contributed to the high resolution rates besides the intervention itself: identifying drugs that may have been appropriately prescribed for a short duration, which may have resolved itself without the intervention, and using the provider feedback as an indication of resolution. To minimize the potential for overestimating the resolution rates and to reduce potential bias introduced by interpretation of provider feedback in future studies, a minimum prescription supply of 45 days will be added diversion, and/or misuse and to optimize pain management therapy to help patients improve their quality of life. The most frequent reason for patient inclusion in the program was the use of multiple pharmacies to obtain the same opioid analgesics. Through the Narcotic Drug Utilization Review program, at least one problem was resolved for 80 percent or more of the identified patients. Most of these resolutions did address the use of multiple prescribers or multiple pharmacies. Prescriber responses indicated that the intervention offered value, prompting actions that may have averted adverse drug events. The favorable outcomes encourage the PBM and MCO to continue the program as an ongoing prescriber intervention, conducted in the interest of patient safety. Today, there are many options to choose from that will help MCOs control the cost of pharmacy benefit programs. All these options should be on the table during contract negotiations. Each strategy offers its own pros and cons for a specific MCO. For example, a per-employee per-month (PEPM) pricing arrangement might work for some 44 MANAGED CARE / MAY 2008
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