Yesterday I had a chance to attend the National Business Coalition on Health’s 19th Annual Conference in Washington, D.C. One common thread I noticed throughout the day was a reminder from speakers that we weren’t just talking about controlling and reducing health care costs but about improving people’s health. The presentation that really humanized things for me, however, was on drug therapy management for children in foster care.
Presenting on this new initiative was Lauren Brophy, Pharm.D., director of drug therapy management programs at PerformRx, the PBM subsidiary of AmeriHealth Caritas. Similar to what PerformRx has done with its award-winning drug therapy management program for diabetes patients, the PBM collaborated with a health plan and a behavioral health specialist to identify gaps in care and ensure appropriate prescription drug utilization.
Members had to be in foster care and either be taking one or more behavioral health medications or be on four of any medication. The audience was stunned when Brophy said about 50% of the foster care population for this plan met this criteria. “That’s really scary that that was the case,” she said. For example, the PBM found that a one-year-old was being prescribed a psychotropic medication. Can you imagine?
Because these medications are often not indicated for pediatric use and can lead to health problems later on, care for these children really needs to be coordinated, urged Brophy. Early results from the program, which started this year, show that on average, one to two medication-related problems are being addressed, usually resulting in the removal of therapy. And in some cases, the therapy is absolutely necessary, but the members need to be seen by a specialist and not just a general practitioner to ensure that they’re on the right medications, she explained.
“These are young patients — they don’t have anyone to be advocates for them — so we as a health plan need to advocate for these patients because a lot of the time they’re just going from home to home, so there’s not a good continuity of care for these members,” said Brophy.
As a mother of small children, this really hit home for me. What medication-related problems in your own pediatric population have you addressed or are you aware of health plans and PBMs addressing?