The Problem
Medication therapy management (MTM) is a proven method of saving lives and reducing overall health care costs by identifying potentially harmful drug-to-drug interactions. Nationally, as many as 200,000 deaths and an estimated 16% of all hospital admissions are linked to medication-related problems. The national Medicare Modernization Act included an MTM services requirement of participating Medicare Part D Prescription Drug Plans (PDP). PDP efforts around MTM have been primarily limited to telephone based screening systems for enrollees identified as high risk.
Use of face-to-face, community-based pharmacist encounters has thus far been very limited. As a result, HWTF created and funded an MTM program for North Carolina seniors that is more effective and accessible than the services that are currently available. HWTF has invested $2 million over three years to place retail and community pharmacists under contract to counsel Medicare enrollees on the most appropriate and cost-effective use of their federal drug benefit. By expanding the availability of counseling services through retail pharmacists, North Carolina has become the first state in the nation to utilize this type of proven, free service for all North Carolina residents age 65 or older who take part in a Medicare Prescription Drug Program.
HWTF Solution (program description)
Launched by HWTF in October 2007, ChecKmeds NC reimburses retail and community pharmacists for counseling eligible seniors on the most appropriate and cost-effective use of their federal drug benefit. Services include a comprehensive “brown bag review” session between the senior and the specially trained ChecKmeds NC pharmacist. The medication review may result in advice, patient education, and/or follow-up with the prescribing physician to discuss medication changes that may be helpful to the senior.
Key Accomplishments (outcomes to-date)
Over 15,000 seniors took advantage of the ChecKmeds NC program during its first year in operation. The program has been credited with avoiding an estimated $10 million in health care costs. In June 2009, the Commission voted to award a directed grant to the Carolinas Center for Medical Excellence (CCME) to assess program outcomes and validate the estimates of the effectiveness, which are based on an estimated cost avoidance model. HWTF plans to share the outcomes of this program with CMS to establish evidence for building stronger medication management programs in future Medicare Part D legislation.