The editors of Drug Benefit Trends interviewed Peter Juhn, MD, MPH, president of the Therapeutic Resource Centers (TRCs) division at Medco Health Solutions, Inc. He discusses the TRC program, launched in 2007, which monitors prescription drug use in patients with specific chronic conditions and is designed to close gaps in care.
Q: Why did Medco create its Therapeutic Resource Centers (TRCs)?
A: Half of our members are taking long-term medications, and they account for about 90% of the drug spend and 75% of the medical spend. So to provide value as a PBM, to help our clients better manage their health care costs, and to help patients manage their medical conditions, we’ve focused on those patients taking long-term medications to treat a chronic disease.
Q: How have the TRCs impacted patient care? How is this being measured?
A: Because of our extensive data, we know when a patient has a gap in care. There are 2 primary types of gaps in care. The first is an adherence gap, in which the patient is not taking a prescribed medication on a regular basis. The second is an omission gap. This is when the evidence is strong that a patient should be taking a certain drug, but he or she is not taking that drug.
Once we identify patients who have those gaps, our pharmacists provide outbound calls and counseling to the patients. Often, the patients call us and our system routes them to a specialist pharmacist in the relevant clinical area. Shortly after the counseling session, a claim comes in and we see that the patient is now taking his medication on a regular basis.
Q: Through the TRC initiative, has prescription volume increased through the Medco by Mail program?
A: It’s hard to answer that because of the recession. We should say that we’ve held steady. This may mean we’ve seen an increase because other prescription volumes have declined.
Q: How have the TRCs changed because of the recession?
A: When talking with patients about why they’re not taking their prescription medications on a regular basis, we’re hearing more and more patients saying the economy is making it harder for them to fill their prescriptions. That leads to additional counseling by us about how they are jeopardizing their health by not taking their medication regularly.
It also leads to opportunities for us to discuss other alternatives with them. For example, there may be generic equivalents for their medication. Or, there may be other means of getting the medication. Some patients facing financial challenges may be eligible for patient assistance programs offered by some of the larger pharmaceutical companies.
Q: How does this program differ from what other PBMs may be offering?
A: First, we are leading with a clinical approach. When we have these conversations with patients, it’s about the disease that they have and how the drug will help them with that disease.
One of the startling things that we’re realizing is that patients just do not have good sources of information about the drugs they’ve been given for their disease. Part of that may be because of the communications they have with their physicians. Given the stresses patients feel when they are visiting a doctor, remembering all that information may be a challenge.
The second of the differences that we see is the quality of the interaction on the telephone. During a call, patients don’t feel the pressure that exists in a retail setting. There is privacy. No one can hear the questions they are asking. This leads to a more meaningful interaction and provides a real opportunity for what I call “true counseling” to occur between the pharmacist and the patient.
The third way we may be different from other approaches is that the TRCs are part of our overall program. This is not, say, a disease management program where we’re charging something extra to the client.