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AIS's Health Business Daily
Featured Story May 7, 2008 Prescription Solutions Develops Model for Boosting Drug Safety and Lowering Costs for Elderly PatientsReprinted from DRUG BENEFIT NEWS, biweekly news, data and business strategies for health plans, PBMs and pharmaceutical companies. By Neal Learner, Managing Editor, (nlearner@aispub.com) As health plans and PBMs grapple with ways to better manage drug utilization in their Medicare Part D members, Prescription Solutions is holding up its geriatric drug monitoring program as a model for boosting drug safety and lowering costs of elderly members. A top executive at Prescription Solutions says finding ways to improve drug safety among the elderly is a topic on the forefront of many health plan and PBM minds. Indeed, other plans and PBMs, including Aetna Pharmacy Management and Walgreens Health Services, have developed successful medication therapy management programs for seniors in their Part D programs. Such efforts are necessary in light of the well documented risks of drug use among the elderly, says Brian Solow, M.D., vice president and medical director of clinical services at Prescription Solutions, a PBM division of UnitedHealth Group. "A lot of hospital admissions, up to 30% in the elderly, have been linked to medication toxicity and drug-related problems," Solow tells DBN. For its part, Prescription Solutions' Geriatric RxMonitor Program has had a "significant" impact in addressing this problem, Solow says. Prescription Solutions says it began looking at the problem of geriatric prescriptions as part of its polypharmacy program in 2001. The Geriatric RxMonitor Program has screened more than 1.3 million seniors so far. Of this group, 12.7% were found to have at least one prescription claim for "drugs to be avoided in the elderly" (DAE), according to the PBM. When the company finds such a DAE, it contacts the provider with a series of mailings, including:
"The education letter also lets them know they are still the physician in charge, and they know their patient best," Solow says. "We're only going off of claims data, so we give them leeway to say, 'I know what's best for my patient and I'm aware of this.' And sometimes that's all we really want from the doctors, that they're aware of this possible medication that shouldn't be used. But if they feel it's being fulfilled appropriately, that's OK." So far, the program has resolved DAE situations for 65.7% of the roughly 70,000 members in the program. Among members targeted for interventions, the number of DAE prescriptions dropped 57% from 126,227 to 53,772, according to Prescription Solutions. The interventions also resulted in a 50% decrease in DAE prescriptions costs from avoided refills (from $11.50 to $5.60 per targeted member per month), it added. Model for MTM Programs? For such results, the Geriatric RxMonitor Program recently won a Silver Award in a nationwide competition sponsored by accrediting body URAC. The competition recognized health management programs that "empower and protect consumers." The recognition, announced in March, comes as many health plans and PBMs are waiting for CMS to issue guidance on designing effective Part D medication therapy management (MTM) programs. Solow says that the Geriatric RxMonitor program originated as one of Prescription Solutions' Part D MTM programs. But unlike most MTM programs — which often reach only a small percentage of beneficiaries due to narrow eligibility requirements — Geriatric Rx Monitor is applied to the entire Part D membership, he says. Other winners in URAC's PBM award category are Express Scripts, Inc., which won the Bronze for "Express Scripts Generics Today," and MemberHealth, LLC, which won the Gold for "Improving ACE-I Utilization in Medicare Part D." For more information
on the Geriatric RxMonitor Program, visit www.prescriptionsolutions.com.
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