Thrifty White Program Improves Medication Adherence in Diabetes

Thrifty White Pharmacy, a chain of 93 pharmacies in the Midwest, is helping diabetic patients better manage their A_1c levels and other aspects of their disease as part of a pilot medication adherence program.

“From our view, that is where pharmacy needs to go. It’s not about just filling scripts anymore, it’s more about clinically managing these patients and driving outcomes,” said Jeremy Faulks, PharmD, Director of Specialty Pharmacy at the Thrifty White Pharmacy based in Plymouth, MN.

The chain’s nine-month-old program, which includes 150 patients, is funded in part by a grant from the Minnesota Department of Health.

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“We started taking this approach in the last five or six years. We really invested in adherence and [in] driving quality, and looked at how we can make our stores perform better than our competitors,” Faulks said.

After starting a successful medication synchronization program, which allows patients to pick up all their medications on the same day every month, Thrifty White executives looked for other ways they could help patients. “Diabetes came to the forefront,” Faulks said.

“Diabetic patients usually have three to four other conditions, and are costing the health-care system a lot of money because they are not well-managed,” Faulks said. Thrifty White pharmacists then talked to insurers about their primary challenges. “They talked about specialty drug spending and how diabetics go to the hospital and the emergency room more often,” Faulks said.

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“We work with local health plans on how we can save them money and are looking to go to employer [health plans] as well,” Faulks said. “We have worked with them on other programs in the past, and we have a handful of employers who have said they would like to send all their diabetic patients to us.”

The diabetes medication adherence program is based on getting patients on the right medications and staying adherent to those drugs, so diabetics don’t develop more serious complications with diabetes, according to Faulks.

In this program, the patient first goes through a comprehensive medication review by a Thrifty White pharmacist. The pharmacist then customizes a program and creates goals, which could include an exercise plan, better drug adherence, and dietary/ lifestyle changes.

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Next, the pharmacist checks A_1c, blood pressure, and cholesterol to establish baseline levels. “We also enroll them into our med sync program … so we can have monthly touch points,” Faulks said.

Two months later, when the patient picks up his or her medications as part of the chain’s medication synchronization program, the patient sits down with a pharmacist to determine optimal drug therapies, find opportunities to save money, and answer any questions, according to the chain.

Thrifty White’s clinical team also calls enrolled patients monthly to review their goals, offer coaching and encouragement, screen for side effects and missed doses, and schedule patients’ next in-store pickup appointment. The chain offers in-store blood pressure testing to monitor progress.

Pharmacists check A_1c levels quarterly. If the levels are not in the recommended range, they work with the patient’s doctor to optimize therapy.

Thrifty White does not as yet have results from the pilot program.

The pilot program currently includes only patients with uncontrolled diabetes who “really need it the most,” Faulks said. “We have a subset of patients who are really hard to manage. We enroll them in the program and work with either the health plan or the employer, and really motivate them to come in.”