Ask an Adviser: How can pharmacists improve care by picking up where PBM services leave off?

Welcome to Ask an Adviser, EBN’s weekly column in which benefit brokers and advisers answer (anonymous) queries sent in by our readers. Looking for some expert advice? Please submit questions to askanadviser@arizent.com. This week, Matt Baki, SVP of Strategic Accounts for Tria Health, weighs in on the following: How can pharmacists pick up where PBM services leave off?

Pharmacy benefit managers, or PBMs, manage prescription drug benefits for health insurers, self-funded employers and other payers, among other tasks. While important, these services are episodic in nature and do not consider the whole patient — nor do they provide the level of care patients with complex drug regimens require.

This is where clinical pharmacists can pick up where the PBM services leave off. As of 2004, pharmacists are required to complete an accredited Doctor of Pharmacy (PharmD) program to be a licensed pharmacist. Through such education and training, pharmacists become the true experts in how medications work.

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Through one-on-one consultations with patients, pharmacists can conduct comprehensive medication reviews (CMRs) to identify the problems keeping patients from achieving drug therapy goals, which essentially put patients at risk for health complications. CMRs include the review of prescriptions, OTCs, vitamins and supplements. Common drug therapy problems uncovered include adverse drug reactions, medication non-compliance, the need for a different drug, a dosage that’s too high or low, the need for additional therapy and unnecessary therapy.

Once identified, pharmacists can advocate for the patient and communicate directly with the prescribing physicians on the issues at hand and what actions can be taken to ensure each medication is safe, effective and appropriate. Pharmacists also can support physicians by providing patients with education on their conditions, as well as ways to properly manage their health through lifestyle modifications and medication use. Increasing patient health literacy improves health; a team-based care model that includes pharmacists working with physicians is extremely effective at improving clinical outcomes for high-risk patients with chronic conditions while lowering healthcare costs.

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According to the 2018 Annals of Pharmacotherapy, the estimated annual cost from non-optimized medication use was $528.4 billion in 2016 U.S. dollars (16% of total spend). This is an unnecessary problem we cannot ignore.

Is the extra cost from non-optimized medications really worth paying? Action is not a heavy lift. Start by evaluating your health management strategy. If pharmacists are not part of your benefit offering, talk to third-party providers that follow a team-based care model involving pharmacists. Analyze your claims data. How does your prevalence of polypharmacy and comorbidity rates compare benchmarks? At a minimum, encourage your plan members to have all their medications reviewed at least annually by a PharmD.