By Jane Brissett

Mar. 24, 2008 (McClatchy-Tribune Regional News delivered by Newstex) --
Paul Deputy takes six prescription medications a day and over-the-counter drugs for his medical conditions, so when he had a severe allergic reaction in November, the emergency room physician advised him to have his medicines analyzed to be sure a drug interaction wasn't the source of the problem.

It turned out that he had developed a reaction to almonds, not his meds. But about the same time the University of Minnesota Duluth, where Deputy is dean of the College of Education and Human Services, was just beginning its Medication Therapy Management Clinic. He enrolled and went there to have them analyzed.

At the clinic, pharmacist Melissa Bumgardner found that he was taking a nonprescription medication that he didn't need and that two of his prescription medications were available as one pill. She recommended the combined pill to his physician. The doctor took the recommendation.

Clearing his prescriptions resulted in reduced costs for Deputy and gave him peace of mind. The university's self-funded insurance plan paid for the consultation and will continue to do so as long as he meets with Bumgardner at least quarterly and adheres to his medication plan.

"It saves us money and it saves them [UMD] money," he said.

Larger benefits realized in other communities -- and expected at UMD -- are that patients are healthier. They have fewer visits to emergency rooms and fewer hospitalizations. Often, patients don't know why they are supposed to take a drug and don't comply with the instructions, Bumgardner said. That's easy to do with so-called silent diseases such as high blood pressure because patients don't feel sick, she said.

HIGH COSTS

Health-care costs for employers are high, but many people don't realize that the cost in lost productivity is even higher, health-care consultant John Riedel said.

One study, conducted by Riedel for pharmaceutical giant GlaxoSmithKlein's Center for Value-Based management, estimated that in 2003 employers lost more than $1 trillion from lost work days and reduced productivity by people with chronic diseases.

The cost of treatment for 100 million people who have chronic diseases, meanwhile was a mere $277 billion, he said.

The medication therapy management idea originated about 12 years ago in Asheville, N.C. The city is self-insured and was looking for ways to reduce health-care costs, especially for people with chronic diseases. Because the patients did so well on the program and costs were reduced dramatically, it became a national model.

At UMD, the program is voluntary but is designed for patients who take four or more medications for two or more chronic conditions, including epilepsy, heart disease, lung disease, high blood pressure and depression.

The Medication Therapy Management Clinic at Kirby Student Center began Nov. 5. Twenty-five people out of 3,200 eligible UMD employees, dependents and retirees have enrolled. It's too soon to judge the results, said Karen Chapin, manager of health programs for the university, but it's being piloted with the idea of eventually offering it throughout the system.

REWARDS

There are rewards for patients who enroll and stick with the program. For example, co-pays are cut almost in half for name brand medications and waived for generic drugs, said Randy Seifert, senior associate dean at UMD's College of Pharmacy.

For the patient who takes five medications, each with a $20 a month co-pay, that's a $1,200 annually saving if the person switches to generics as a result of consultations with one of the program's two pharmacists, Seifert pointed out.

University officials adopted the pilot program because medication therapy management has been highly successful in other places.

"The return on investment has been running on average 4-to-1," Seifert said. A recent journal article pegged the ratio at 12-to-1, he said. Among the users is the federal Medicare program.

The city of Duluth began the program on March 11 with 100 of 860 eligible people enrolled. The city expects to net $400,000 in savings on health-care costs this year as a result of the program even though it is incurring $175,000 in additional costs, said Eric Simonson, who chairs the city labor-management health insurance committee. The city is using pharmacies in the community for counseling.

Most importantly, studies have shown that patients in the program generally see their health improve. For example, in the Asheville Project, diabetes patients showed a 1.4 percentage point improvement in a long-term measure of control over blood sugar. "A change of this magnitude has been associated with significant long-term improvements in diabetes complications," Carole Cranor, a doctoral candidate at the University of North Carolina, Chapel Hill, wrote in an article in Pharmacy Times in October 1998. Their cholesterol readings also improved.

Over 12 months, inpatient hospital claims fell by nearly $39,000 for the 46 patients in the program, Cranor wrote. Even with additional expenses of the program such as spending more on medications, outpatient visits, pharmacist consultation and, depending how the program is set up, reducing or eliminating co-payments, the city's costs fell by more than $20,000.

Physicians have the final say about medications as pharmacists can't prescribe drugs, but for the most part they have taken the UMD pharmacists' recommendations, Bumgardner said. "The information I've gotten back from my patients' physicians has been overwhelmingly positive," she said.

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