Medication Therapy Management Program

Medication Therapy Reviews

The medication therapy review is a systematic process of collecting patient-specific information, assessing medication therapies to identify medication-related problems, developing a prioritized list of medication-related problems, and creating a plan to resolve them. The reviews can be comprehensive or targeted to an actual or potential medication problem. Whether comprehensive or targeted, the individual patient’s medications are evaluated in the context of the patient as a whole, taking into consideration all of the patient’s conditions and medication therapies.

Why is Medication Therapy Management needed?

Medication-related problems and medication mismanagement are a massive public health problem in the United States. Experts estimate that 1.5 million preventable adverse events occur each year that result in injury and death, costing $177 billion.

Physician-prescribers and members are much more likely to accept and implement recommendations from independent Clinical Pharmacists who are not associated with the PBM. Consequently, PPCN’s Medication Therapy Management activities yield superior results to traditional programs.

PPCN is 100% independent and fully committed to improving patient outcomes, which generates savings for the plan sponsor and its members. It has no ties to pharmaceutical firms or other major health care vendors. And, there are no rebate arrangements or soft-dollar reimbursements that can influence PPCN’s work.

Everything PPCN does for its clients is 100% transparent. The analyses performed and the cost savings recommendations will be fully explained in laymen’s terminology.

This program uses a targeted approach with a focus on risk and cost

o There is a high level of communication between pharmacist, patient and physician in this program.

o Using claims analysis, high risk and high cost patients will be identified based upon drug spend, number of prescriptions, number of disease states and targeted therapeutic drug classes.

o A Clinical Pharmacist will review each patient’s medication profile to identify drug interactions, duplicate therapy, multiple prescribers, adverse drug reactions, poly-pharmacy issues, generic and therapeutic substitution opportunities and make preferred drug interventions.

o The Clinical Pharmacist will create an action plan consisting of recommendations to address therapeutic issues.

o The Clinical Pharmacist will communicate with the physician and the patient to act upon recommendations.

o Using claims analysis, the actions taken based upon the Clinical Pharmacist’s recommendations will be reconciled.

o Using the original action plan and the claims analysis, a report quantifying the projected cost savings and the actual cost savings will be provided for the employer.

o The Clinical Pharmacist will conduct a patient compliance consultation to review the changes in drug therapy.

Benefits

o Rapid results are seen by patient and the employer, as the patient’s drug regimen can be changed quickly and the employer can begin realizing immediate medication cost savings.

o Reduction of drug costs by eliminating duplicate, ineffective and or expensive therapy.

o Reduction of physician visits, emergency room visits, hospitalizations, tests and procedures due to less than effective or inappropriate therapy.

o The new drug regimen should yield improved clinical results when compared to the previous therapy.

o The program can generate a 2:1 Return on Investment.

Pricing

Initial fee: The initial fee will be based upon the size of the insured population and the estimated cost savings opportunity.

Cost savings share: PPCN will receive 35% of the actual cost savings projected for the upcoming 12 months, as measured by prescription claims.

*PPCN will guarantee a savings equal to the initial fee.