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Positive Outcomes Revealed In Study Of Pharmacy Care Management Services For Medicare Advantage Members


A Recent Study Published In NEJM Catalyst Highlights The Favorable Results Of A High-Touch Pharmacy Care Management (PCM) Service For Medicare Advantage (MA) Members Identified As High-Risk. The Research, Conducted By A Team From UPMC Health Plan And Rxante, Demonstrates That Implementing A Targeted Program Incorporating Pharmacist Care Management, Medication Reconciliation, And Convenient Medication Packaging Delivered To Patients’ Homes Leads To Reduced Pharmacy Spending, Fewer Inpatient Hospital Stays, And Improved Medication Adherence.

The Study Aimed To Assess The Impact Of An Integrated PCM Program On MA Beneficiaries With Multiple Chronic Conditions, Including A Subset With High Predicted Cost Savings Attributed To Enhanced Medication Adherence. A Total Of 724 PCM Participants Were Compared To 3,620 Control Members Who Received Standard Pharmacy Care. The Average Age Of PCM Participants Was 68 Years, With 38% Being Male, And They Were Taking An Average Of 11 Maintenance Medications Daily.

Results Showed That PCM Program Participants Experienced A Decrease In Medical Spending By An Average Of $108 Per Enrollee Per Month Compared To Non-Participants. For Patients With A High Value Of Future Adherence (VFA) Score, This Savings Was Even More Significant At $406 Per Enrollee Per Month. Furthermore, PCM Participants Had 15% Fewer Inpatient Stays Overall, With A 32% Reduction In Inpatient Stays For Those With A High VFA Score.

Co-Author Chronis Manolis, R. Ph., The Chief Pharmacy Officer At UPMC Health Plan, Emphasized The Cost-Saving And Health-Improving Potential Of A Targeted PCM Approach, Noting That It Not Only Benefits Individual Patients But Also Contributes To Lower Downstream Healthcare Costs And Utilization.

The PCM Program Involved A Comprehensive Process That Included Tele-Onboarding Appointments To Review Medication History And Synchronize Refills, As Well As Home Delivery Of Medications In 30-Day Cycles. Mosaic Pharmacy Service, A Subsidiary Of Rxante And A Partner Of UPMC Health Plan, Provided Data-Driven Clinical Pharmacy Services To Ensure Effective And Consistent Pharmacy Care For Program Participants.

The Findings Of This Study Are Particularly Relevant As Medicare Advantage Plans Face The Challenge Of Managing Costs For Medically Complex And Vulnerable Populations. Co-Author Josh Benner, Pharm.D., Sc.D., Founder, And CEO Of Rxante, Highlighted The Importance Of Tailored Pharmacy Services For High-Risk MA Members, Pointing To The Broad Availability Of Mosaic As A Value-Based Pharmacy Service For Medicare Advantage Plans Nationwide.

The Study Underscores The Positive Impact Of A Targeted PCM Program On Health Outcomes And Cost Savings For MA Members With Multiple Chronic Conditions, Demonstrating The Potential Of Such Interventions To Optimize Medication Use And Improve Overall Patient Well-Being.

1. Source: Coherent Market Insights, Public sources, Desk research
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