S.C. pharmacists help shape Medicaid reform


South Carolina officials looking to reduce costs in the state Medicaid program have tapped pharmacists to help in the effort by improving drug selection and adherence. The South Carolina Department of Health & Human Services is offering a $1.98 million grant to the South Carolina College of Pharmacy (SCCP) to implement the program, which will focus on Medicaid patients diagnosed with mental health disorders, HIV/AIDS, or cancer.

"The purpose of the program is to economically optimize how drugs are used in the Medicaid system to reduce costs while maintaining quality," explained Joseph DiPiro, Pharm.D., executive dean of SCCP, recently formed with the merger of the pharmacy schools of USC and the Medical University of South Carolina. "It is very important that we find ways to control drug expense," he said. The program is initially contracted for two years, but pharmacy school officials are hopeful it will last longer. He expects to hire a program director in early 2007.

Through efforts like this program, states are in fact beginning to rein in rising Medicaid costs. Earlier in the decade, Medicaid expenses were frequently rising 10% or more per year in many states, causing significant concern and pushing states to adopt a number of cost-cutting measures. According to Kaiser Family Foundation research, in fiscal year 2005 (the latest for which data are available) Medicaid spending rose 6% in South Carolina, compared with a 5% nationwide average. In 2005, South Carolina spent $500 million on Medicaid prescription medications-nearly 12% of the $4.2 billion program.

Kerr noted that the state is also piloting another program that will give doctors on-line access to patients' Medicaid records to provide them with all the information they need to make the right decisions. Information ranging from pharmacy receipts to other medical procedures is available in a "digital dashboard" on the doctor's computer so that physicians can recognize when patients fail to purchase medications, get refills, or other problems that might adversely affect their care.

Instead, education and improving the quality of care will be the primary focus in South Carolina. According to DiPiro, the program will get pharmacists out front talking to the physicians that are prescribing medications for Medicaid patients. "Pharmacists will interact with prescribers, offering information, guidelines, and a whole range of options," he said. "Pharmacists might pay a visit to an office or hold continuing education seminars. They will have a presence in the clinics, similar to the way pharmaceutical company representatives work."

Still, in important respects, the perspective of program pharmacists will differ from that of the drug company sales staff. "We are not telling the drug company story," DiPiro insisted. "We'll back up our recommendation with drug information experts and create evidence-based guidelines." He noted that the program will also rely on doctors and pharmacists as part of an advisory board, with the goal of providing balanced information.

Initially, the program will focus on key areas where Medicaid expenses are most acute: mental health, cancer, and HIV/AIDS. The patient's health and adherence are the program's top priorities, rather than directing people to less costly drug alternatives. In some cases more expensive drug therapies may be more beneficial in the long run. By refining the areas, moreover, the college will also be able to study the results and chart its success or failure to improve outcomes and/or reduce costs over time.

DiPiro also sees the program as part of a broader transformation of the pharmacy industry into a result-oriented profession. "This program is very important for us," he said. "It uses our talents in pharmacy very well. We have the chance to have a large influence on medication use and to put pharmacy at the forefront of the healthcare debate."

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