Blue Cross and Blue Shield of Illinois

 

January 25, 2013

Rx Health AdvisorSM Program Is Minimizing Medication-Related Problems
Results for 2012 (Pilot Year) Are Encouraging

Prescription drug use in the United States has significantly increased over the last decade.1 Increasingly, more people are receiving prescriptions from multiple practitioners at different sites of care. All too often, this results in poorly coordinated treatment of chronic conditions.

An accelerating trend, this has the potential to be detrimental to patients’ health, and expensive for employers and the patients themselves. In fact, incidence estimates suggest that:

  • More than 1.5 million preventable medication-related adverse events occur each year in the United States,
  • Accounting for an excess cost of $177 billion in terms of medication-related morbidity and mortality.2

Reversing the Trend
The Rx Health Advisor ― launched in January 2012 by Blue Cross and Blue Shield Plans in Illinois, New Mexico, Oklahoma and Texas (BCBS) ― is a medication therapy management (MTM) program designed to help doctors ensure appropriateness, effectiveness, safety, and proper use of medications prescribed to their patients/our members.

Rx Health Advisor also promotes cost-saving opportunities, such as generic alternatives, increased utilization of mail order services and enrollment in a specialty pharmacy program for BCBS members with chronic conditions.

To date, the program is posting encouraging results, including cost savings.

Utilization information from a BCBS member’s medical and medication claims history is assessed to help identify potential drug therapy issues, such as:

  • Usage of excessive medications, or poly-pharmacy (multiple prescription drug claims from various prescribers or filled at different pharmacies)
  • Duplicate drug therapy
  • Potential drug-to-drug interactions and complications
  • Mismatch between prescribed drug therapy and documented medical condition

How the program works:

  1. When a BCBS member with potential drug therapy issues is identified, the prescribing physician is contacted by the Rx Health Advisor pharmacist.
  2. This contact includes suggested recommendations for the physician’s consideration to address the issues noted.
  3. All MTM (medication therapy management) information is provided to assist physicians in managing their patient’s care, and is not intended to replace their clinical judgment.

2012 Rx Health Advisor key findings:

  • More than 7,500 MTM (medication therapy management ) cases were reviewed.
  • Within the 7,500+ MTM cases, more than 2,100 Medication Action Plans were generated for provider review.
  • More than 4,200 recommendations were made within those 2,100 Medication Action Plans.
  • Providers accepted an average of 30 percent of the recommendations made by the MTM clinical pharmacists to address the identified drug therapy issues, resulting in more than $700,000 in projected pharmacy savings.

1 According to the Kaiser Family Foundation, the number of prescriptions filled each year increased by 39 percent between 1999 and 2009, and the amount of money spent was $234 billion in 2008.

2 Medication Therapy Management in Pharmacy Practice: Core Elements of an MTM Service Model, the American Pharmacists Association and the National Association of Chain Drug Stores Foundation, Version 2.0, March 2008, p. 3.

 
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A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.