CMRs May Reduce Hospitalizations and Pharmacy Costs
San Diego—Data has shown that medication therapy management (MTM) can improve patient outcomes. MTMs can be deployed by several av- enues including internal teams at health plans, retail pharmacy, and third-party MTM companies. However, little data is available describing the effectiveness of each individual method of comprehensive medication review (CMR)—telephone versus retail face-to-face.
In a new study, researchers sought to evaluate the effect of CMR on hospitalization and total pharmacy costs on patients with chronic obstructive pulmonary disease (COPD). The results were presented at the AMCP meeting during a poster session titled Comparison of Telephone vs Face-to-Face Comprehensive Medication Reviews in COPD Patients.
Using Humana MTM and pharmacy claims data from January 1, 2010 to December 31, 2012, researchers conducted a retrospective claims level data analysis on patients with a diagnosis of COPD within 1 year prior to the index date. Other inclusion criteria included enrollment in a Medicare prescription drug plan, continuous membership from 1 year prior to the index date through 1-year post-index date, continuous enrollment in the MTM program for the study duration, and completion of at least 1 CMR during the study period. Patients in the control group were required to have membership in Humana from 2009 to 2013 and be continuously eligible for MTM from 2010 to 2012 and never completed a CMR. The primary end point was COPD-related hospitalizations within 1 year. Secondary end points included total pharmacy costs, plan pharmacy costs, and out-of-pocket pharmacy costs.
The findings showed that fewer patients with a CMR had a COPD-related hospitalization compared with patients without a CMR (19.2% in 2011 and 18.7% in 2012 vs 31.3% and 21.9%, respectively). Furthermore, in 2011 and 2012, patients with a CMR had a lower mean prescription out-of-pocket cost, prescription plan cost, and total prescription cost compared with the control group. For example, the total prescription out-of-pocket cost in 2011 and 2012 for patients with a CMR was $547.80 and $570.41 versus $771.16 and $600.48 for patients with no CMR, respectively.
The data also showed that there was no statistically significant difference between the type of CMR completed and COPD-related hospitalization for patients who completed a CMR in 2010 or 2011, but a difference was shown in the 2012 group to favor face-to-face consultations compared with telephonic consultations (351 vs 293, respectively). In general, there was no difference between CMR type and prescription spend. In 2012, the average prescription out-of-pocket cost was higher in the telephonic CMR group than the face-to-face group ($644.96 vs $520.45, respectively).
The researchers concluded that “completing a CMR may reduce the risk of hospitalization and may reduce pharmacy costs for patients and plans.”
Study limitations acknowledged by investigators included that medical claims data was not used in the study. Costs reflected in this study did not reflect total annual spend, but only pharmacy spend. Also, the quality of CMR completion was not evaluated in this study. Although all completed CMRs met the Centers for Medicare & Medicaid services requirements, CMRs were not standardized by an inde- pendent organization.—Eileen Koutnik-Fotopoulos
This study was supported by Humana, Inc.
