Medco using clinical pharmacists as specialists in direct patient care

There's never been much love lost between pharmacists and pharmacy benefit management companies. It's ironic therefore that Medco, the nation's largest PBM by revenue, is breaking new ground in the use of clinical pharmacists as providers of direct patient care.

"No other medical professional is as well trained in medication management, and we use that. Our innovation is to separate cognitive pharmaceutical services from the dispensing process in our training," said Glen Stettin, M.D., senior VP and head of the clinical and therapeutic solutions group for Medco.

But when claim and lab data-provided by Medco's health plan and employer clients-determine that a patient has a specific chronic condition, those prescriptions are sent to pharmacists who are trained by Medco in the particulars of that condition and work at one of nine therapeutic resource centers.

The program, running for about two years, has trained 700 "specialist pharmacists."

"We're already working with a highly motivated healthcare professional with six years of schooling in drug therapy," said Stettin. "So we go further. We train our specialist pharmacists in the current medical knowledge of specific diseases. We provide a new sense of mission, adding value to care."

When a specialist pharmacist sees a problem, such as an inappropriate drug or dose, a contraindication based on medical condition or drug interaction, or noncompliance based on claims data, they contact patients directly, often by phone. That is followed, as necessary and with patient permission, with a call to a patient's physician, often resulting in a prescription adjustment-sometimes avoiding a life-threatening medication error, or sometimes just making a drug affordable by moving to a different medication or a generic substitute.

An example of an intervention is in connection with Symlin (pramlintide acetate), an injectable used by insulin-dependent diabetes patients at near mealtime to help control blood sugar spiking. Much lower doses of Symlin are required for Type 1 diabetes patients than Type 2 patients. If a Type 1 patient takes too high a dose, the result can be a hypoglycemia attack. The drug was approved for manufacturer Amylin Pharmaceuticals by the Food & Drug Administration in 2005 and made a big splash on the market after its release.

"Our specialist pharmacists know about this drug and its dangers because they are specialists in diabetes medication, up to date on therapeutic options," said Stettin. "Primary care physicians may not all have that knowledge. They primarily are treating Type 2 diabetes and also this is a new drug.

"We know this represents a transformation in the practice of pharmacy in recent years," added Stettin. "We know that by using these professionals in this manner, we are making a contribution to improving medical care."

THE AUTHOR is a writer based in Gettysburg, Pa.