Medication optimization with PGx reduces Medicare costs and hospital use
A medication optimization program that included pharmacogenomics was associated with a 19.4% reduction in total medical costs among Medicare ACO members, saving an average of $246 per member per month, according to a Health Affairs Scholar study. The program combined pharmacogenomic testing, a medication-risk algorithm, comprehensive pharmacist review, and recommendations to prescribers. Inpatient admissions decreased by 43.1% and emergency department visits by 41.3%. Savings increased with longer participation, reaching 31.9% for members enrolled beyond nine months. (Health Affairs Scholar)
More durable payment models needed for pharmacist services
Health systems need more durable ways to pay for pharmacist services whose benefits extend beyond the pharmacy department, according to a Health Affairs Scholar paper. The authors propose shared-savings arrangements for high-acuity care, where pharmacists may help reduce medication costs, adverse drug events, hospital stays and readmissions. They also call for broader provider recognition, better reimbursement and stronger systems for documenting outcomes. For CMM, they suggest per-member-per-month payment as one option. (Health Affairs Scholar)
Practice Transformation
Billing for embedded pharmacists is feasible, but requires transformation
Embedded pharmacists across nine University of Colorado primary care clinics provided CMM and chronic-disease services. Existing billing pathways generated an estimated annual reimbursement potential of only about $36,000 per pharmacist; pharmacists reported spending a median 45% of clinic time on billable activities. The authors conclude that billing is feasible, but the services are unlikely to be financially self-sustaining without changes that increase billable activity. (Journal of the American Pharmacists Association)
Evidence & Innovation
VHA integrates techs to expand PGx
The Veterans Health Administration has developed a clinical pharmacy technician model to help scale its PGx program, which now operates at 157 facilities and has completed more than 150,000 PGx orders. Six technician positions were piloted to handle functions including patient identification and outreach, consent, laboratory coordination and triage of lower-risk gene-drug alerts. Clinical pharmacist practitioners retained responsibility for advanced PGx care and program leadership. Early qualitative experience suggests the model may reduce pharmacists’ administrative workload and improved the timeliness and reliability of PGx processes. (American Journal of Health-System Pharmacy)
Policy Solutions
VA model standardizes systemwide CMM
A Journal of the American College of Clinical Pharmacy article describes how the Veterans Health Administration has used standardized policies and processes to expand comprehensive medication management across the nation’s largest integrated health system. Clinical pharmacist practitioners work under scopes of practice that allow them to initiate, discontinue and modify medication therapy for patients with established diagnoses. Standardizing CMM practice and credentialing pharmacists through the same process used for other non-pharmacy providers allow for less variation among facilities and support broader integration of clinical pharmacy services. (JACCP)
