BETHESDA, MD 03 August 2009—A Wyoming program that paid pharmacists for face-to-face medication consultations with state residents has fallen victim to budget woes, but the program`s basic premise has taken root elsewhere in the region.
Wyoming`s Pharmacy Technical Assistance Program, better known as PharmAssist, began enrolling state residents in 2004. The program paid pharmacists to provide a one-time medication consultation with the goal of helping enrollees to better manage their drug regimens and medication costs (see April 15, 2004, AJHP News). Operated through the state department of health, PharmAssist saved participants about $1100 in medication costs per year, on average, said Program Manager Sheila Clement.
Participating pharmacists received up to $120 from the state for their hands-on work with each PharmAssist enrollee.
But funding for the program was eliminated at the July 1 start of the fiscal year as part of a 10% across-the-board state agency budget cut requested by Wyoming Governor Dave Freudenthal.
Donna Artery, pharmacist consultant for the health department`s Office of Pharmacy Services, said PharmAssist enrollees and participating pharmacists were very enthusiastic about the program. But the enrollment figures did not attain a level to make the program sustainable in the current budget environment.
Clement estimated that PharmAssist enrolled 15–20 state residents annually during the program`s last two years, after the Medicare Part D prescription drug benefit went into effect.
"The bulk of our clients were over age 65," Artery explained. When these Wyoming residents gained pharmacy benefit services through Medicare Part D plans, Artery said, enrollment in PharmAssist went "way, way, way down."
"So even though we have really good results, we just don`t have very many clients," she said in June.
A newer program in Montana that was modeled after PharmAssist—and even shares the PharmAssist name—may also be feeling the effects of Medicare Part D but is still operating.
"It`s been slow growing," said Roger Citron, the sole pharmacist at the Montana Department of Public Health and Human Services and director of the state`s PharmAssist program.
Montana`s PharmAssist program was created under a 2005 state law and funded with tobacco tax revenues. Citron said the program had to complete a lengthy process of administrative development before launching its first training sessions for pharmacists in 2007.
Pharmacists become credentialed for PharmAssist through a free continuing-education program administered by the University of Montana Skaggs School of Pharmacy in Missoula, which will evaluate and report on data from the program.
Citron said several hospital pharmacists have undergone the training, although not all trained pharmacists have completed contracts with the state to perform the consultation services.
Participating pharmacists are expected to provide "a comprehensive accounting of all medical conditions and medication therapies giving a complete picture for building personalized treatment plans," according to the PharmAssist website.
Citron said PharmAssist seeks to "develop that relationship between the pharmacist, the patient, and the doctor to really show the value of the three working together" to improve patient care.
The state has authorized payment to pharmacists of up to $125 for each counseling session. Citron said pharmacists have received payments for their services within a week after submitting the required documentation.
Nineteen participating pharmacists were listed on the website in mid-July. Only a handful of residents—four, in all—had completed a fully documented session by this past June, Citron said.
But Citron said a new round of contracts is near completion, and he believes PharmAssist will pick up steam over the next year.
"I hope we have 30–50 actively participating pharmacists," Citron said. "It would be ideal if they were all referring at least one patient a month."
He said retired pharmacists have shown an interest in PharmAssist.
"They really saw this as the future of the profession, that trying to get pharmacists paid for their cognitive skills was where the profession has to go," Citron said. "A few signed up, and I`m hoping to get them more actively enrolled and participating."
Citron said PharmAssist is not actively advertising but is instead relying on participating pharmacists to identify clients and get them enrolled in the program.
"We know the need is there, it`s just trying to identify the right patients," Citron said. He also noted that until pharmacist participation expands throughout the state, the logistics of one-on-one counseling are better if the pharmacists work locally with their existing patients.
Like its Wyoming predecessor, Montana`s PharmAssist program is open to all state residents regardless of their income or insurance status.
"But financially, it`s the people that have the deductible and the [Part D] doughnut hole, or have no insurance, or who have a new disease state that are really going to find the value in this program," Citron said.
Although Medicaid beneficiaries are eligible for PharmAssist, Citron said the program is not specifically targeting them. But he said that that might change in the future if pharmacist recruitment expands enough to support a push to enroll Medicaid beneficiaries.
Colorado has such a program, dubbed Rx Review, that uses Wyoming`s PharmAssist program as a model. Medicaid beneficiaries are identified by the state health department on the basis of medication use and offered the opportunity to meet with a pharmacist for a medication review. Participating pharmacists receive $75 per counseling session.
Artery said that before her department`s budget was cut, Wyoming`s PharmAssist program was eying Medicaid beneficiaries as potential participants in the program.
"We have actually thought about just taking a look at all of our Medicaid patients that, say, are on 10 medications or more [to see if] we could save them any money, or if we think they`re duplicating any therapy," Artery said.
"That was kind of the direction that our plan was going until the economy came to a screeching halt, and everybody decided we need to cut programs. So, maybe someday."
