Economic impact of pharmacist-reimbursed drug therapy modification

Abstract

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. Cross-sectional, retrospective, descriptive study. Midwest United States in 2006. Not applicable; 767 paid therapeutic interchange service claims from the PBM database were analyzed. Descriptive statistics for PBM costs and cost savings to the PBM and to patients were calculated using all prescription fills. ROI calculated by dividing net savings across all fills by net costs. 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. 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.