PerformRx’s Award-Winning Drug Therapy Management Program Curbs Increases in Health Care Costs

—Findings of Two Programs Published in The American Journal of Managed Care

—Program Receives URAC Best Practice, Dorland Health Case In Point Awards

PerformRx ( www.performrx.com ), a URAC-accredited, full-service pharmacy benefits manager with industry-leading clinical programs, announced the results of two pivotal programs demonstrating that its member-centric drug therapy management (DTM) product, which engages pharmacists to help optimize therapeutic outcomes, curbs participants’ increases in utilization and health care costs. The results of the programs were published in the March 2014 issue of The American Journal of Managed Care.

Both programs included members of Medicaid managed care health plans who have diabetes, use 15 or more medications and have a mean seven-fold greater disease burden (a health problem’s impact in terms of financial cost, mortality or morbidity) than their respective overall memberships.  

In the first year-long program, DTM participants from a large Philadelphia-based Medical Assistance (Medicaid) managed care health plan were reviewed for medication-related problems, which pharmacists addressed with evidence-based prescriber and patient interventions. This group was then compared to members who did not participate in the program.  Among the more significant findings were:

  • A 10 percent decrease in the rate of inpatient admissions, compared with a 66 percent increase for non-participants.
  • A 3 percent decrease in the rate of emergency room visits, compared with a 17 percent increase for non-participants.
  • A 4 percent increase in total per member, per month health care costs, compared with a 52 percent increase for non-participants (a 48 percentage point improvement).

In a separate year-long program, DTM participants from AmeriHealth Caritas Pennsylvania, a Medical Assistance (Medicaid) managed care health plan serving 26 Central and Northwestern Pennsylvania counties, were reviewed for medication-related problems, which pharmacists addressed with evidence-based prescriber and patient interventions. This group was then compared to AmeriHealth Caritas Pennsylvania members who did not participate in the program. Participants in the program experienced a reduction in the rate of increase in health care utilization and costs, including:

  • A 4 percent increase in total per member, per month health care costs, compared with a 55 percent increase for non-participants over the same span (a 51 percentage point improvement).
  • A 6 percent increase in the rate of emergency room visits, compared with a 26 percent increase for non-participants (a 20 percentage point improvement).
  • An 8 percent increase in the rate of inpatient admissions, compared with a 44 percent increase for non-participants (a 36 percentage point improvement).

“Research has shown that patients who manage diabetes with multiple medications have a harder time adhering to their medication regimen and a greater likelihood of experiencing medication-related health problems. We developed this program to address these challenges,” said Mesfin Tegenu, M.S., R.Ph., president of PerformRx. “A comprehensive DTM program with strong collaboration between pharmacy and care management can keep chronically ill patients out of the hospital, improving their quality of life and reducing health care costs.”

Tegenu added that the company is currently utilizing its Drug Therapy Management product with patients with COPD, asthma and Hepatitis C. “Our goal is to leverage this powerful program with a variety of chronically ill populations to help them better manage their conditions and improve health outcomes,” he said.

In 2013, PerformRx’s Drug Therapy Management product received a Silver Best Practice award for health care consumer engagement and protection from URAC and a Case In Point Platinum award from Dorland Health in its Managed Care Programs category.

About PerformRx, LLC

PerformRx, LLC, a full-service pharmacy benefit manager, is one of the nation’s leaders in providing an innovative and integrated technology-driven approach to results-focused pharmacy benefit management programs. Driven by the strength of its leaders and passion of its employees, PerformRx helps payers improve patient outcomes while achieving high quality. For more information, visit www.performrx.com .

About The American Journal of Managed Care
The American Journal of Managed Care, now in its 20th year of publication, is the leading peer-reviewed journal dedicated to issues in managed care.  In December 2013, AJMC launched The American Journal of Accountable Care, which publishes research and commentary devoted to understanding changes to the healthcare system due to the 2010 Affordable Care Act. AJMC’s news publications, the Evidence-Based series, bring together stakeholder views from payers, providers, policymakers and pharmaceutical leaders in the areas of oncology, diabetes management, respiratory care, and immunology and infectious disease. For more information, see www.ajmc.com.

# # #

Michelle Davidson
Tel: 215-863-6364
mdavidson@amerihealthcaritas.com 

About PerformRx, LLC
PerformRx, LLC, a full-service pharmacy benefit manager, is one of the nation’s leaders in providing an innovative and integrated technology-driven approach to results-focused pharmacy benefit management programs. Driven by the strength of its leaders and passion of its employees, PerformRx helps payers improve patient outcomes while achieving high quality. For more information, visit www.performrx.com .

About The American Journal of Managed Care
The American Journal of Managed Care, now in its 20th year of publication, is the leading peer-reviewed journal dedicated to issues in managed care.  In December 2013, AJMC launched The American Journal of Accountable Care, which publishes research and commentary devoted to understanding changes to the healthcare system due to the 2010 Affordable Care Act. AJMC’s news publications, the Evidence-Based series, bring together stakeholder views from payers, providers, policymakers and pharmaceutical leaders in the areas of oncology, diabetes management, respiratory care, and immunology and infectious disease. For more information, see www.ajmc.com.

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About Us

AmeriHealth Caritas is one of the nation’s leaders in health care solutions for those most in need. AmeriHealth Caritas operates in 16 states and the District of Columbia, and serves more than 4.8 million Medicaid, Medicare and CHIP members through its integrated managed care products, pharmaceutical benefit management services, behavioral health services and other administrative services. Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven company with 30 years of experience serving low-income and chronically ill populations. For more information, visit www.amerihealthcaritas.com.

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