Medco to have prescription review system

When a patient gets a new prescription filled, there's a fair chance a pharmacist will be looking over the doctor's shoulder, more or less. Increasingly, pharmacists are aggressively reviewing prescriptions — mainly those for expensive, chronic conditions — and counseling patients and intervening with their doctors to head off costly, potentially deadly problems.

"It's a significant trend across practice settings," from drug stores and hospitals to mail order pharmacies and even a few doctors' group practices, Anne Burns, a vice president at the American Pharmacists Association, said Monday.

The efforts are sorely needed, given that medication errors have long been a problem, exacerbated by patients who see multiple doctors, get confused about what to take when or may even split pills to save money. The Institute of Medicine last year reported at least 1.5 million preventable medication errors occur annually and that it costs at least $3.5 billion to treat the resulting injuries; it urged pharmacists and doctors to work more closely with patients so they understand medication regimens and errors are avoided.

Experts say some pharmacists already were doing so and more are getting involved.

"It's a very positive development," part of the trend toward personalized medicine, said Mark Merritt, president of the Pharmaceutical Care Management Association, a trade group for pharmacy benefit managers, which process prescriptions and aim to hold down insurers' costs.

The latest, possibly largest program was to be launched Tuesday by Medco Health Solutions Inc., a pharmacy benefit manager serving 60 million people. The Franklin Lakes-based company has trained 700 pharmacists so far, each on one of seven complex, chronic conditions, and set up a resource center for each condition at its mail order pharmacies.

Computers flag incoming prescriptions for patients with those conditions — such as diabetes, cancer and infectious diseases — for a specialty pharmacist to review them if necessary. The pharmacists look for dosing errors, interactions with other drugs, whether the patient isn't refilling prescriptions as directed, or if a new medication would be better. Patients can call 24 hours a day, seven days a week with questions, even about effects of nonprescription drugs.

The launch includes an advertising campaign featuring famous Olympic Gold Medal-winning athletes with chronic health conditions.

One is diver Greg Louganis, who has been HIV-positive for two decades. When his doctor prescribed an anti-inflammatory medicine recently, Medco called him and the doctor to say that drug might interfere with the AIDS medicines he takes, Louganis said. The doctor agreed and made an adjustment.

"A specialist pharmacist acts as another set of eyes" for patients, he said. "It has given me such peace of mind."

Some of the Medco's competitors offer similar services for patients with complex conditions, including Express Scripts Inc. and CVS Caremark Corp. On Monday, WellPoint Inc., the biggest U.S. insurer, said it is starting such a service in-house, covering 14 different complex illnesses.

Dr. Michael Cohen of the Institute for Safe Medication Practices called the services worthwhile and said having pharmacists trained on one condition as Medco does seems particularly beneficial.

Last year, Medicare began paying pharmacists at independent and chain drug stores to provide an annual review and counseling for patients with multiple chronic illnesses and medications. John Norton of the National Community Pharmacists Association said independent pharmacists have more time for counseling than competitors at chain pharmacies.

Less than 10 percent of Medicare patients are getting that service so far, but the Medicaid programs in 10 states have started such services over the last several years and Veterans Affairs outpatient clinics have had pharmacists doing so even longer, Burns said.

Parallel to those efforts, numerous health and community groups now are campaigning for patients to be more assertive in asking questions about medicines, said Jim Conway, senior vice president at the nonprofit Institute for Healthcare Improvement.

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On the Net:

Pharmaceutical Care Management Association: http://www.pcmanet.org

National Community Pharmacists Association: http://www.ncpanet.org

Medco Health Solutions: http://www.medco.com