Estimating the value of pharmacist interventions in a specialty pharmacy setting

Background: As the pharmacist (RPh) role has evolved from a dispensing to a clinical focus, the need to demonstrate the value of routine RPh interventions is necessary to drive the profession forward. In 2018, Saulles and Chang reported an estimate of the financial impact of 716 RPh interventions in a regional health system specialty pharmacy to be $299,415. While RPh-led anticoagulation and medication therapy management (MTM) is well established with reducing medical costs, the value of daily specialty pharmacy care is not as well studied despite interventions being made frequently. Aims: The objective of this study was to analyze the interventions in a specialty pharmacy and to provide an estimate of the economic value in terms of both RPh time and the potential adverse events (AEs) or unnecessary medical costs prevented had the intervention not taken place. Methods: In this retrospective study, interventions documented at Ardon Health specialty pharmacy were categorized using a coding system. A way to identify certain interventions was developed to distinguish a subset of interventions (termed RPh impacts) that directly led to or had a high likelihood to prevent negative outcomes. Impacts documented in 2017 were reviewed by a RPh, and the actual or predicted outcome, such as avoidance of hospitalization or medication waste, was predicted. A financial value was then attributed to each impact. The 2006 Health Care Utilization Project report was used to estimate the costs of prevented hospitalizations. Other costs were estimated using emergency room (ER) visit costs available in the literature and actual costs of avoided medication waste. Two scenarios were completed: one in which all the prevented outcomes were predicted to occur, and one where 50% of the total cost of prevented outcomes would be incurred. Surveys were completed by the RPhs to estimate the average time per intervention to estimate the value of devoted RPh time. Results: A total of 14,441 interventions were documented, of which 115 were identified as RPh impacts. The total estimated value of interventions ranged from $2,518,442 to $4,603,358, with an estimated value per intervention of $174 to $319. Most of the RPh impacts were predicted to have prevented an unnecessary hospitalization. Conclusions: While the estimative nature of this analysis poses limitations, the analysis demonstrates the profound clinical and economical value of RPh care in a specialty pharmacy setting.