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Change in prescription and medical services costs and utilization: an employer initiated diabetes disease management program in a community pharmacy setting

Sujit Sansgiry, Harshali Patel, Shivani Mhatre, J David Hayes, Kim Roberson, Clyde James


Background, aims and scope: Diabetes is a considerable economic burden on the healthcare system and is one of the leading chronic diseases targeted by managed care organization to reduce cost.

Methods: The current study aimed to evaluate the impact of an employer initiated, patient-centered diabetes disease management program in a community pharmacy setting on reducing per member per year medical services and prescription drug costs and utilization. Further, improvement in clinical indicators from baseline was assessed in this cohort. Trained pharmacists administered the program including, but not limited to, clinical assessments, developing a personalized medication plan, patient education and self-monitoring guidance. Individualized follow-up visits were scheduled approximately every 2 months to monitor routine progress. The diabetes disease management program was initiated in 2007 and continued through 2008. It was anticipated that the effect of the intervention would not be immediate; thus, outcomes were compared across the 2 years of the intervention: 2007 and 2008. A comparison of economic and clinical outcomes was conducted on 85 enrollees who had at least 3 visits. Economic outcomes were assessed in terms of difference in all-cause utilization and costs, for prescription drugs and medical services.

Results: Prescription drug utilization increased significantly by 12 claims per member per year from 2007 to 2008 (p=<0.0001). A significant increase was observed in average per member prescription payments by $1,550 (p=<0.0001) in these years. Although not significant, mean medical charge per member reduced from $15,180 in 2007 to $11,590 in 2008 and total healthcare cost reduced by $2,090 from 2007 to 2008. Clinical indicators (HbA1C and blood pressure) significantly improved from 2007 to 2008.

Conclusion: An employer initiated, patient-centered diabetes disease management program in a pharmacy setting had an impact in optimizing medical services and prescription drug costs and utilization.

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