Frequency and Characteristics of Cognitive Services Provided in Response to a Financial Incentive

Pharmacy Participation and Claim Characteristics in the Wisconsin Medicaid Pharmaceutical Care Program from 1996 to 2007

“…In spite of possible desires by pharmacists to provide services and expand their practices, patronizing community pharmacies was 7.5 minutes, with 94% of PC interventions taking less than 20 minutes. 17 Our results show that over the duration of the study period, there was an increase in the number of claims submitted for the 0 to 5 minute level, consistent with the increase in the proportion of "drug choice" reason codes. Pharmacists appear to focus on tasks requiring a small amount of time but are also involved in more complex medication therapy management activities.…”

“…This pattern of a few pharmacies participating at high rates is similar to those observed in other studies examining programs that pay pharmacies for services and raises some questions. 2,[17][18][19] Do these pharmacies serve a larger proportion of Medicaid patients, making the benefits of program participation worth the costs of participating?…”

“…4,5,17,18 Trends in the number of claims paid by the different reason code categories showed an increase in the proportion of interventions targeting drug choice, with corresponding increasing trends of contacting physicians as an action and adjusting fills as a result. One explanation for the shift to more emphasis on drug choice issues is the creation of other programs that pay pharmacists for nondispensing services by private payers.…”

“…Analyses of these programs show that drug choice issues are common reasons that pharmacists are paid for services. 17,21 In addition, formulary restrictions may require drug changes, and drug choice services are relatively easy to provide and can be identified and implemented by trained technical staff in a pharmacy, thus reducing the cost of providing the service. Given that the enhanced dispensing fees have not increased over the program duration, developing systems to involve lower-cost technical personnel in the provision of PC services is a potential strategy to make participation economically sensible.…”

Current Status of Prospective Drug Utilization Review

“…These studies have documented a problem detection and intervention rate of between 1% and 5% of all prescriptions dispensed, with changes in drug therapy occurring 40% or more of the time. 23,24 In one long-term OBRA '90 demonstration study, Christensen et al 25 documented pharmacist cognitive services over a 20-month period. The most common type of drug problem intervention involved patient-specific understanding of instructions for use and medication compliance rather than problems with the drug or drug regimen itself.…”