Impact on Drug Costs and Utilization of a Clinical Pharmacist in a Multisite Primary Care Medical Group

OBJECTIVES: To measure the cost and utilization outcomes of a pharmacist intervention in a primary care medical group operating under a financial risk contract with a health plan. METHODS: A prestudy-poststudy design using national drug utilization for the comparison was employed to assess the impact of physician-prescriber education using information derived from prescriber-specific drug cost and utilization analyses. Eight therapeutic areas involving 10 drug classes were targeted (antihistamines, nasal steroids, proton pump inhibitors, histamine-2 receptor antagonists, antidepressants, nonsteroidal anti-inflammatory drugs [NSAIDs, including celecoxib and rofecoxib], antibiotics, angiotensin-converting enzyme [ACE] inhibitors, calcium channel blockers, and statins). The subject medical group was an independent, nonacademic, ambulatory, primary care medical practice of 65 primary care physicians consisting of 50 internists, 14 pediatricians, and 1 family practitioner. Drug costs were measured as net medical group costs per enrolled member per year (PMPY), the product of the average cost per prescription, and the number of prescriptions PMPY. RESULTS: The increase in drug cost PMPY for this medical group was 1.7% in a commercial contract in 1999 compared with an increase of 31.2% for health plans nationwide. Utilization as measured by prescriptions PMPY did not change in the national data comparison over the 2-year observation period and increased by 4.0% in the medical group. The national average cost per prescription claim increased 31.2% in 1999 compared with a decrease of 2.1% in the medical group. The decrease in average drug cost in this medical group was associated with an increase in the use of preferred drugs, including more generic drugs. CONCLUSIONS: A targeted educational program for physician-prescribers conducted by a clinical pharmacist working for a primary care medical group can reduce the expenditures for outpatient drug therapy by lowering the average cost per pharmacy claim.