Medication therapy management program attracts Medicare patients

A medication therapy management program conducted among eligible Medicare Part D members last year by Health Net Inc. (Woodland Hills, CA), a national insurer and managed care organization, has yielded a 50:50 split in interventions to change drug use—half to improve medication adherence and fill care gaps, and half to decrease therapeutic duplications and reduce drug costs, according to preliminary data. The program, run by Health Net’s Pharmaceutical Services PBM subsidiary, enrolled 90,000 members who suffer from multiple chronic diseases and take multiple prescriptions. Its goal is to improve how they take their drugs and to potentially decrease their pharmacy expenses.

Of the more than 162,000 drug-related problems identified, pharmacists intervened in approximately 50,000 cases to increase adherence to a prescribed drug regimen; in 45,000 cases to explain potentially adverse drug interactions; in 44,000 cases to reduce cost of care; in 20,000 to fill gaps in care with doctors; and in 3,000 to stop duplicate drug therapy.

The 90,000-member enrollment translates to 90% participation among those eligible, according to Health Net Pharmaceutical Services, surpassing the 65% participation rate of similar free, voluntary programs. As a result of the participation rate, Health Net says, the Centers for Medicare and Medicaid Services (CMS) has selected the MCO as one of only 10 Medicare Part D sponsors to participate in a pilot medication therapy management program.

Entire health picture

“The medication therapy management program presents an entire picture of a patient’s health because we not only involve members but the many individuals who may help them: caregivers, physicians, and pharmacists as well as our pharmacists and care coordinators.” said Virginia E. White, Pharm.D., FCSHP, senior vice president and chief clinical officer at Health Net Pharmaceutical Services, in an announcement.

The Health Net pharmacists review some 5,000 member profiles weekly for drug-related problems, according to the company. Pharmacists send letters containing their findings to members, encouraging them to speak with a medication therapy management pharmacist and to bring the letters to their next doctor appointment. The pharmacists also discuss the drug-related problems with their colleagues at Managed Health Network, Health Net’s behavioral health subsidiary, for potential psychosocial intervention.

The Centers for Medicare and Medicaid Services recently selected Health Net as one of ten Medicare Part D sponsors to participate in a pilot program to perform in-depth analysis on medication therapy management outcomes. Health Net says it expects outcome data to be available this summer. CMS requires all insurers offering Part D plans to also offer a free and voluntary medication therapy management program to eligible members who have multiple chronic diseases, take multiple drugs, and are likely to incur at least $4,000 in annual pharmacy costs.