By Scott Wooldridge - Contributor

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How Blue Cross pharmacists help seniors manage their Rx regimen

January 11, 2018

Prescription drugs create mixed feelings for many seniors—they are both life-saving and life-enhancing, but prescribed medications can be expensive, complicated and cause troublesome side effects.

In recognition of Pharmacists Day (Jan. 12), Blue Cross and Blue Shield of Minnesota is highlighting its program to improve and simplify the medication routines for seniors — a practice known in the health care industry as “medication therapy management.”

Marypat Habermas, PharmD., a medication therapy management pharmacist, who works mainly with Blue Cross Medicare members, recently answered a few questions about how Blue Cross helps seniors manage their medications to ensure their best possible health.

Tell us a little about the medication therapy management program at Blue Cross.

We follow a federal program, which is administered by the Centers for Medicare and Medicaid Services (CMS) and follows the Medication Therapy Management (MTM) model. This concept came into play in 2007, when Medicare created several quality improvement measures known as Star Ratings.

In the simplest terms, seniors who have certain medical conditions or take several medications are referred for a comprehensive medication review, commonly known as a CMR.

The MTM program allows us to take the needed time to catch these potential problems and will hopefully keep people healthier and out of the hospital.

What goes into a “comprehensive medication review”?

We conduct a detailed phone interview with eligible members. This usually takes about a half hour.

What we’re trying to do is go through and make sure that all the medications they’re taking make sense for them at this point in their life.

A pharmacist will talk with the member and look over all of their pharmaceutical information, including what medications they’re buying over-the-counter.

We ask about side effects or any other issues going on, including things that might not show up on most drug interaction screenings. If there are issues that turn up, we work with their primary care team to address those issues.

Some of what we’re doing is providing members with education about the medications they are taking.  We’re also looking to see if our member is taking any medications that they may not need. There might be, for example, some drugs they’re using that might increase their risk for other conditions. There are lots of moving pieces.

Why is it necessary to review medications?

It’s all too common that doctors may only have ten to fifteen minutes with their patient during an appointment. Often, this means that doctors simply don’t have enough time go through all their medications and symptoms and re-evaluate where their patient is at.

We can help fill in that gap so that nothing is missed for our member. We will go through their entire medication list and make sure they’re getting the correct outcomes from their medications. This can have a very positive effect toward improving their overall health.

Does this this type of approach have a real medical impact for participants?

That’s the hope and it certainly can. This was created to solve a very real issue:  the third-most common reason for hospitalizations—and the number one reason for falls among seniors—are issues with their medications.

They could be taking too much, or not enough. There could be side effects.

The MTM program allows us to take the needed time to catch these potential problems and will hopefully keep people healthier and out of the hospital.

How do you identify which Blue Cross enrollees take part in this program?

Last year our pharmacists completed CMRs with about 3,000 members who qualified for the program. We want to reach as many members as possible and our goal is to significantly to increase that number this year.

So, what’s the bottom line for Medicare enrollees?

We want our members to know that we work closely with their primary care teams to make sure they’re getting the best outcomes. We work together to make sure they’re getting the best bang for their buck, not experiencing bad side effects, and making informed choices about prescription drugs. Our goal is to help our members get a medication regime that is best serving their health.

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