Community pharmacists help HMO cut drug costs

Twenty-seven independent community pharmacies that were preferred providers for a health maintenance organization (HMO) were enrolled in a study to determine the effect of increased intervention activities on the cost of a drug benefit in a managed care environment. Pharmacists from nine pharmacies were trained to initiate changes in medication prescriptions to contain costs, to enhance communication with patients and prescribers, and to intervene in drug-related problems. Their intervention activities during the nine-month study period were compared with activities of nine pharmacies assigned to a control group and nine pharmacies assigned to a comparison group. Patients who visited the intervention pharmacies had a 6.5% lower prescription mean ingredient cost; a 6.0% higher generic substitution rate; an 8.3% lower average patient drug cost per month; and no difference in the days supply, the average number of prescriptions per patient, or the aggregate hospital admission rate. The pharmacists in the intervention group spent more time with patients before preparing prescriptions (2.4-fold increase); initiated more requests for prescribers to change prescriptions (2.5-fold increase); intervened more often to reduce the cost of drug therapy (3.7-fold increase); and suggested medication changes more often for better quality of care (1.9-fold increase). In this study, community pharmacists altered their practice procedures and settings to foster communication with patients and prescribers. Also, the prospective drug regimen review changed prescribing patterns: physicians permitted increased use of generic medications, which reduced monthly prescription expenditures.