MTM program increased statin use
Initiative averted major coronary events, saved money
Educating physicians about statins resulted in more physicians prescribing the drugs and financial savings from averted major coronary events, according to a study of a medication therapy management (MTM) program. The study, “Effect of an Intervention to Increase Statin Use in Medicare Members Who Qualified for a Medication Therapy Management Program,” was published in the August Journal of Managed Care Pharmacy. It looked into Carlsbad, CA–based Prescription Solutions’ MTM program for Medicare Advantage Prescription Drug Plans patients. MTM programs are a key part of Medicare Part D—the idea is to use the expertise of pharmacists and pharmacy benefit managers to educate beneficiaries and the healthcare industry as a whole.
In the study, Prescription Solutions, a pharmacy benefit management company that provides prescription drug benefits for commercial, Medicare, and government health plans, employers, and unions, mailed educational materials to prescribers to increase statin use among members with diabetes or CAD who had not filled prescriptions for statins in the previous six months. The study sought to estimate the potential cost savings of such a program.
The study found that the MTM program and greater use of statins saved an estimated $12,323 in cardiovascular costs for 220 members who received the program intervention. In a four-month follow-up period, 12.1% of members whose prescribers received the intervention began taking statins. The report also found that 11 members would need to be treated with a statin medication for a median of 5.4 years to avoid one major coronary event. (See “Estimate of costs avoided during a 5.4-year period” on the PDF.)
“As a result, it would be necessary to conduct the intervention with prescribers of 220 members to avoid one major coronary event,” wrote the researchers.
Brian K. Solow, MD, FAAFP, vice president and medical director of clinical services at Prescription Solutions, says statins have significantly reduced the risk of death and major coronary events and reduce the risk of a second heart attack. However, only about one-third of patients hospitalized after a heart attack receive statins at discharge. Two factors account for this, Solow says. Doctors are busy and may forget to prescribe statins, and medication compliance with statins is difficult.
Researchers identified 1,340 members and 1,275 prescribers for the intervention. Prescription Solutions then mailed a patient-specific report to prescribers that showed which members under an individual physician’s care could benefit from statin therapy. The mailing also included a section for prescriber feedback and a prescriber educational booklet.
Solow says the study focused on prescribers rather than patients because physicians have the most effect in this kind of intervention. He adds that member- and nurse-targeted intervention statin initiation programs have not been as successful as prescriber-targeted programs. “If you involve the physician in a respectful manner and get them on board, your intervention, as we have proven, will go farther,” Solow says.
How does an MTM program effectively engage prescribers when physicians are already busy and inundated with other information? Solow says step one is to respect the physicians, who are the ultimate caregivers.
He says an MTM outreach program can do this by offering accurate information through claims data and make only evidence-based recommendations.
This physician-targeted intervention is only one of Prescription Solutions’ MTM programs. The company has also seen success in a geriatric prescription monitoring program that has reduced the risk of inappropriate medications being prescribed for those aged 65 and over.
The program identified nearly 13% of the 1.3 million program enrollees who had at least one prescription claim for a drug they should avoid. Through an educational mailing to physicians, Prescription Solutions was able to resolve about 66% of the conflicts, Solow says. Given the proven benefits of statins and the results from this study, he believes there will be more studies focusing on education, adding that the MTM program shows that pharmacy benefit managers can help ensure appropriate, safe, and effective use of prescription drugs. A pharmacy benefit manager isn’t there to limit drugs to clients, but to focus on quality and total patient care.
The study highlights the importance of ongoing education, Solow says. Pharmacy benefit managers are there to be “an adjunct partner with health plans in the care of the patient and, by doing so and accepting some of these processes, they can help their client and their overall health costs.”