Stacy Ramirez is a faculty member at Oregon State University, yet spends the majority of her time in clinical practice working with primary care homes in Benton and Linn Counties.
Speaking at a conference co-sponsored by the Oregon Association of Health Underwriters and the Pharmacy Benefits Academy West, she told participants that clinical pharmacists have become problem solvers, helping patients not only receive the appropriate drug therapy, but also helping them “figure out how they’re going to afford their drug therapy.”
She described one particular patient, a 59-year-old diabetic with high cholesterol and hypertension, a smoker who abused alcohol and was homeless. “This gentleman actually saw me every week. If he didn’t come to me, I went and found him” whether that was in a bar, under a bridge or, eventually, in the home of his daughter,” said Ramirez, a clinical assistant professor in the Department of Pharmacy Practice at OSU. “Once I started seeing him, he had no more hospitalizations. We’re going on our 19th month. Now I see him once a month.”
Using this clinical pharmacy service model, pharmacists “don’t ask permission to change meds but keep providers aware of what we’ve done,” she said.
Legislation under consideration, House Bill 2028, would let the Board of Pharmacy define the practice of clinical pharmacy and handle agreements between providers and pharmacists. It would expand statewide protocols and allow -- but not mandate -- reimbursement.
“We want to open a door to conversation,” said Josh Bishop, who recently was director of pharmacy services and is now the vice president and Idaho regional director for PacificSource Health Plans. “We don’t want mandates.”
Expanding the role of pharmacists beyond dispensing drugs could have a profound impact on workforce shortages, while clinical pharmacy services can save money and lives, he said. “Pharmacy is the most common medical intervention. It’s a convenient benefit” and, as a result, usually 28 to 30 percent of medical budgets are spent on pharmaceuticals.
Failure to properly manage medication is costly in many ways. The New England Healthcare Institute estimates that $290 billion a year is wasted on mismanaged medication and 1.1 million deaths annually are associated with mismanagement of meds.
Bishop said the U.S. Public Health Service released a report to the Surgeon General in 2011 that showed having pharmacists on primary care teams saved $10.07 for every dollar spent between 1988 and 2005.The return on investment was as high as 12:1 on complex patients with an average ROI of 3:1.
Intervention by pharmacists also avoided hospitalizations and emergency room visits.
In a 2012 study of 15,000 patients, $5.9 million was saved with $387 saved per patient and $140 saved per encounter.
PacificSource contracts with pharmacists to help manage high-risk members -- those with more than three diagnoses and more than three medications or more than $3,138 in annual drugs costs.
In the future, Bishop predicts “pharmacists will practice at the top of their license, easing demand on primary care providers. Truly, that’s where this transformation is going to be.”
Jan can be reached at [email protected]
