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Purpose: Reimbursement for clinical pharmacy services is often problematic and not always effective. Here we describe a novel reimbursement model and preliminary results stemming from a contract between a School of Pharmacy and the University’s self-insurance administration to offer comprehensive medication reviews to the University self-insured population.
Methods: A 1-year contract was signed, with optional renewal, that enabled the school to offset the salary of two ambulatory care clinical pharmacists, each at 0.5 FTE, hire administrative help, and cover other miscellaneous expenses. The services were marketed to both beneficiaries as well as providers through newsletters, mailings, and a website. On April 4, 2012, the clinical pharmacists began offering 30-minute appointments to beneficiaries and their adult dependents without a fee-for-service. The services were offered one or two half days each week, rotating among one of the five campuses within a 90 mile radius. Additionally, visits were conducted at varying locations on each campus to make it more convenient for beneficiaries.
Results: Thus far, 52 comprehensive medication reviews of 402 medications have been performed, resulting in the clinical pharmacists making 128 interventions for an average of 2.46 interventions per comprehensive review. Interventions included 74 prescription medication-related problems and 116 over the counter medication-related problems. The medication-related problems consisted of 16 adverse drug events, 6 drug interactions, 5 untreated conditions, 69 medications without an appropriate indication, 35 inappropriate medications for an indication, 4 inappropriate dose regimens, 10 cost concerns, 18 adherence issues, and 23 needing additional education. There were 2 adverse drug events that were considered severe or life-threatening.
Conclusion: The service will continue to be offered to all beneficiaries with a goal of targeting high-risk patients based on medication claims data.