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Evaluation of the economic and clinical impact of community pharmacist-driven pharmacy benefit management services

Published:April 05, 2019DOI:https://doi.org/10.1016/j.japh.2019.03.016

      Abstract

      Objective

      To evaluate the economic and clinical impact of community pharmacist–led pharmacy benefit management (PBM) services.

      Setting

      Independent community pharmacy in western North Carolina.

      Practice description

      Sona Benefits is a PBM partner to self-funded plans in western North Carolina. The services provided by Sona Benefits are led by pharmacists at its affiliate company, Sona Pharmacy + Clinic.

      Practice innovation

      In October 2016, Sona Benefits began providing PBM services to members employed by a local continuing care retirement community.

      Evaluation

      Economic outcome measures included change in total medical and prescription costs per member per year (PMPY) and change in cost per prescription from baseline. Change in clinical outcome measures (hemoglobin A1C, weight, blood pressure) was assessed for members who participated in 2 or more quarterly health coaching sessions.

      Results

      Prescription costs were reduced from $1219.72 to $858.57 PMPY and medical health care costs were reduced from $5910.76 to $4290.30 PMPY from baseline. This represented a total decrease of $1981.61 PMPY in health care costs. A reduction in the average cost per prescription from $95.10 to $61.88 was observed. For patients enrolled and active in health coaching, we observed reductions in weight, hemoglobin A1C, and blood pressure. Between the initial and final health coaching visits, average weight decreased from 204.6 lb (92.8 kg) to 203.6 lb (92.4 kg), the percentage of patients at hemoglobin A1C goal increased from 47% to 53%, and percentage of patients at goal for blood pressure increased from 58% to 78%.

      Conclusion

      Inclusion of community pharmacists in PBM service delivery produced economic benefits for plan sponsors. Preliminary clinical data suggested benefits of pharmacist-led health coaching services, but further evaluation is needed to determine the long-term impact.
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      References

        • Centers for Medicare and Medicaid Services
        National Health Expenditure Data.
        (Available at:)
        • Dalen J.E.
        We can reduce US health care costs.
        Am J Med. 2010; 123: 193-194
        • Viswanthan M.
        • Kahwati L.C.
        • Golin C.E.
        • et al.
        Medication therapy management interventions in outpatient settings: a systematic review and meta-analysis.
        JAMA Intern Med. 2015; 175: 76-87
        • Cranor C.W.
        • Bunting B.A.
        • Christensen D.B.
        The Asheville Project: long-term clinical and economic outcomes of a community pharmacy diabetes care program.
        J Am Pharm Assoc. 2003; 43: 173-184
        • Fera T.
        • Bluml B.M.
        • Ellis W.M.
        Diabetes Ten City Challenge: final economic and clinical results.
        J Am Pharm Assoc. 2009; 49: 383-391
      1. American Diabetes Association Standards of Medical Care in Diabetes– 2016.
        Diabetes Care. 2016; 39: S1-S112
      2. American Diabetes Association Standards of Medical Care in Diabetes– 2017.
        Diabetes Care. 2017; 40: S1-S134
        • James P.A.
        • Oparil S.
        • Carter B.L.
        • et al.
        2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8).
        JAMA. 2014; 311: 507-520

      Biography

      Deven L. Jackson, PharmD, Clinical Coordinator, Sona Pharmacy + Clinic, Asheville, NC; at the time of study, PGY1 Community-based Pharmacy Resident, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, and Sona Pharmacy + Clinic, Asheville, NC

      Biography

      Natasha M. Michaels, PharmD, BCACP, Director of Clinical Services and Residency Site Coordinator, Sona Pharmacy + Clinic, Asheville, NC

      Biography

      Brad Melson, PharmD, General Manager and Residency Preceptor, Sona Pharmacy + Clinic, Asheville, NC

      Biography

      Evan Bruder, Director of Business Development, Sona Pharmacy + Clinic, Asheville, NC

      Biography

      Laura A. Rhodes, PharmD, BCACP, Assistant Professor of Pharmacy Practice, Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL; at the time of study, Community Practice Engagement Fellow, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC

      Biography

      Macary Weck Marciniak, PharmD, BCACP, BCPS, FAPhA, Clinical Associate Professor and Director, PGY1 Community-based Pharmacy Residency Program, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC