Impacts of a PBM-Based Disease Management Program on Asthma Medication Use

Abstract

OBJECTIVE: To evaluate the impact of an asthma disease management program conducted by a pharmacy benefit management (PBM) organization. DESIGN: A prospective analysis of the outcomes of an education-based disease management program for a large population of asthma medication users, compared to the outcomes for a matched longitudinal control group. SETTING: Merck-Medco Managed Care, L.L.C., a national PBM that manages prescription benefits and provides mail-service and online pharmacy services. PATIENTS: The intervention group consisted of 19,289 patients with asthma, aged 6 and older, divided into high-risk, low-risk, and maintenance subgroups based on history of asthma medication use. The control group consisted of 19,253 asthma patients matched on age and gender. INTERVENTIONS: Patients in the intervention group received asthma education materials and had call-in access to pharmacists trained in optimal asthma care. Physicians were notified when their patients were enrolled, and they received asthma therapy guidelines if their patients’ medications or self-reported status indicated suboptimal therapy. MAIN OUTCOME MEASURES: Antiinflammatory controller medication (AICM) use and inhaled short-acting beta-agonist medication use. RESULTS: Intervention group patients showed larger increases in AICM use than control group patients (17.8% versus 13.6%, for high-risk patients, p<0.001; 12.7% versus 8.9%, for lowrisk patients, p<0.001). Significant increases in usage of inhaled corticosteroids were found for both highand low-risk groups (p<0.001), compared to the control group. Among patients who started using AICMs, use of inhaled short-acting beta-agonists decreased significantly (p<0.01). CONCLUSION: A PBM-based asthmaeducation program can improve asthma therapy by increasing usage of AICMs and reducing reliance on quick-relief medications. These treatment changes are consistent with clinical practice guidelines, and are associated with improved symptom control and reduced health care utilization and costs.