Impact on drug cost and use of Medicare Part D of medication therapy management services delivered in 2007

Abstract

ObjectiveTo describe experiences with medication therapy management (MTM) services delivered to beneficiaries of Mirixa’s health plan clients. SettingUnited States during 2007. Practice descriptionThree intervention modalities were offered to provide MTM services: community pharmacy, pharmacist-staffed call centers, and educational mailings. Available data were analyzed to identify any differences among patients receiving any of the three interventions. Patients included in the analysis were those who qualified for MTM services between April 1, 2007, and June 30, 2007. MTM services were provided for these patients between May 1, 2007, and December 31, 2007. Practice innovationThe MirixaPro platform was created to document the activities associated with the five core elements of an MTM service (medication therapy review, creation of a personal medication record, creation of a medication-related action plan [MAP], intervention and/or referral, and documentation and follow-up). It provides a framework for capturing safety interventions, follow-ups with prescribers, and pharmacist instructions to the patients. Main outcome measuresPart D drug costs, use, and generic dispensing ratio in the pre- and post-MTM periods. Results21,336 patients received MTM services from a community pharmacist (face to face, 9,140; by phone, 12,196), 3,436 patients received MTM services from a call center pharmacist, and 49,021 patients received an educational mailing. Patients who had a face-to-face session had a decline in mean monthly drug costs of $29 (from $658 to $629), while drug costs decreased by $40 (from $677 to $637) when the community pharmacist provided the services over the telephone. Mean monthly drug costs decreased by $15 (from $676 to $661) for patients receiving MTM services from a call center pharmacist and did not change for patients receiving an educational mailing ($698 in both periods). ConclusionAmong patients who received MTM services in 2007, drug costs decreased for those who received service from community pharmacists, decreased somewhat for patients who received service from a call center pharmacist, and were unchanged for those who received MTM via mailing. Further studies are needed to assess the effect of various types of MTM interventions on financial, clinical, and humanistic outcomes.