Since PerformRx’s inception in 1999, our Drug Therapy Management (DTM) Program has focused on optimizing therapeutic outcomes for our members. As the pharmacy benefit landscape has rapidly grown, our team has continuously leveraged its expertise, staying abreast of an evolving industry to provide the best possible care to our members. Andrew Maiorini, Vice President of Clinical Programs, recently shared his thoughts on how PerformRx’s DTM program has also evolved over the years and how he sees technology and the role of the pharmacist changing in the future.
What are your goals for PerformRx’s DTM program in 2021 and beyond?
The ultimate goal for drug therapy management is to maximize the use of medications to improve members’ overall health. Every program that we provide or create makes this primary outcome the highest priority. We are successful only if the members we serve receive the medications they need to improve their health and well-being.
In what ways has the DTM program grown and evolved during your time with PerformRx?
In the 15-plus years I have been with PerformRx, the drug therapy management we have provided to our clients and to members has changed dramatically. We started our first DTM program not long after PerformRx was formed. We identified a very specific patient population ― members with bleeding disorders ― that would benefit from monitoring and guidance on drug utilization and therapy management. While we first focused on these patients because of the cost of their treatment, it quickly became clear to us that the overall health of these members was directly related to the cost of their care. The healthier the members, the lower the cost. We realized this model could be applied to various disease states and drug therapies.
While the mechanisms used to identify and track patient populations that could benefit from DTM has changed, the underlying principles have not. By improving the care of the members identified, not only will these members have healthier, more productive lives, their total cost of care will also tend to decrease.
Advancements in technology continue to transform the health care landscape at a rapid pace. How do you see these advancements being leveraged to improve outcomes in the future?
There are numerous categories of advancements in the medical landscape that have impacted patients’ health care. New drug therapies, generic drug proliferation, and biosimilar technologies have increased the cost-effectiveness, and therefore the accessibility, of highly effective treatments. Data management allows for more accurate identification and tracking of outcomes. Also, technology has created opportunities to customize outreaches and care management to individual patients.
Some examples include the ability to leverage communication technology to allow face-to-face consultations in circumstances where that typically would not be possible. Connected devices (glucose meters, blood pressure monitors, scales, etc.) allow for patient-specific data to be monitored, which allows for more customized patient interactions and outcomes. As the technology advances, less intrusive technology will help us better understand each member and the impact of care. These technologies will allow more members to have personalized treatment regimens and therefore better health outcomes.
Pharmacy benefit managers (PBMs) occupy a unique space when it comes to member care. In what ways do you see drug therapy management services evolving and expanding to better manage members’ health and well-being over the next several years?
Increases in high-cost specialty medications will continue to drive treatment costs from traditional medical costs to pharmacological treatments. Many disease states that once required inpatient stays or lengthy in-office treatments are now being treated with medications that can be self-administered in the patient’s home. This shift will continue to increase the need for comprehensive drug management programs in order to treat patients effectively. The role of the PBM is increasing not only due to the cost of these medications, but also because of the complicated nature of many of these treatments. PBMs and pharmacists will continue to play a more significant role in the administration of drug therapies and disease state management.
Our programs have seen firsthand the positive impact that clinical pharmacy teams can have on outcomes. How do you envision the role of the pharmacist within a PBM expanding?
Due to the expanding use of self-administered treatments, the expertise of the managed care pharmacist is more valuable than ever. Members will require experts who understand how to best utilize the treatments, how they should be administered, what side effects to be aware of, potential interactions with other treatments, etc. These are all skills that a pharmacist is uniquely trained to provide to our members. Skilled pharmacists will be increasingly in demand to ensure that our members are receiving and using medication therapies appropriately in order to maximize treatment outcomes.
Increasing use of data technology and the volume of data available to the PBM will result in more opportunities for intervention. As programs to improve health and decrease costs become more widely utilized, there will be an increased demand for pharmacists in a PBM setting to provide these services. In the near future, PBM pharmacists will likely see a continued shift away from operational duties to more outcome-based, interactive tasks with members.
At PerformRx, we strive to provide members with high-quality care while ensuring our partners receive favorable costs. What are some cost-effective enhancements you could see being made to drug and medication therapy management programs with the goal of continuously improving patient health outcomes?
Appropriate treatment requires that members receive the correct drug at the correct dose for the appropriate duration. In order to properly treat many disease states, multiple medications are often required. This can result in very complicated drug regimens and increase the risk of non-adherence and potential adverse events from medications. Focusing on these key aspects of drug therapy management will always be the most impactful way to increase positive outcomes and decrease adverse outcomes and costs.
Many technological advancements will increase the ability of DTM programs to be effective. Technologies will allow for continuous monitoring and gathering of data points that were previously unavailable. All of these technologies can result in better outcomes and more accurate outcomes tracking.
Research has shown that DTM programs help to improve the pharmacist-patient relationship. If given the opportunity, how would you advocate for these programs to become more of a focus within the normal responsibilities of a pharmacist?
Numerous studies have demonstrated the value of DTM programs for overall patient outcomes and improved patient satisfaction with care. Pharmacist-led DTM programs provide significant value not only to members but also to the health care payers. Pharmacists have a unique skill in understanding pharmacological treatments and the impact they have on members’ overall health. Healthier members have a better quality of life, higher satisfaction with care, and a lower overall total cost of care. Investing in and increasing pharmacy-led DTM programs benefits the entire health care system.
Based on your knowledge and experience, what does the future of drug therapy management look like to you?
The future of DTM will utilize technology advancements and tools to increase the scope of services as well as increase health outcomes. Technology allows for more customized programs as more data is available to analyze. As technology gets smaller and less intrusive, the number of individuals willing to participate will also increase. The future will bring more comprehensive tools and resources that leverage current technology to expand and improve DTM-related interventions.
If you were recommending PerformRx to a health plan for their DTM needs, what would be the key differentiators you would highlight to set us apart from the competition?
PerformRx began our DTM programs with the goal of improving patient outcomes and reducing overall health care costs. All of our programs have been designed around this philosophy. It wasn’t common for PBMs to be looking at total health care costs at the time we started our programs. This focus differentiates PerformRx’s program from typical PBM programs. Compared with programs designed to only reduce pharmacy costs, without consideration for health care outcomes and total health care costs, our program’s goals are more aligned with those of our clients.
We believe pharmacy benefits shouldn’t be one-size-fits-all, which is why we offer customizable solutions that are built to perform.
Email PerformRx today to learn how our DTM programs can help improve your members’ health and well-being.