Retrospective analysis of community pharmacists' recommendations in the North Carolina Medicaid medication therapy management program

Objectives: To determine the economic impact of cost-saving alternatives on prescription drug costs for the North Carolina Medicaid medication therapy management (MTM) program and to assess the acceptance of recommendations made by pharmacists to prescribers and the implementation of accepted recommendations. Design: Retrospective analysis. Setting: 92 Kerr Drug pharmacies in North Carolina from August 1, 2006, to July 31, 2007. Participants: 88 North Carolina Medicaid beneficiaries who received at least 12 prescriptions each month and who completed four quarterly medication reviews by a Kerr Drug pharmacist. Intervention: Assessed recommendations made by Kerr Drug pharmacists. Main outcome measures: Rate of acceptance of pharmacist recommendations and overall economic impact of changing from brand-name medications to cost-saving alternatives. Results: Acceptance rate of pharmacist recommendations ranged from 42% to 60%. The rate at which the pharmacists' accepted recommendations were implemented at Kerr Drug pharmacy ranged from 62% to 86% across the four quarterly reviews. Overall economic impact resulted in an average cost savings of $107 per beneficiary to North Carolina Medicaid per year. Quarterly economic impact results revealed that the highest impact occurred during the first quarterly review at $63 per beneficiary. Conclusion: Prescriber acceptance and pharmacy implementation of cost-savings alternatives provided an annual average cost savings of $9,444 to North Carolina Medicaid. After pharmacist reimbursement, this savings totaled $2,724.