The Rx For Savings: Pharmacists’ Role in Value-based Care

| May 1, 2019

John Nicolosi PHARM D Chief Clinical Officer CerpassRx pharmacists in action quote

There’s a shortage of primary care physicians (PCPs) in the U.S. By 2030 we could lack 105,000[1] physicians needed to provide necessary health care services. Despite this growing need, a group of highly-trained clinicians continue to be underutilized—pharmacists. To help bridge the gap in care, lower drug costs and elevate patient outcomes, a trip to the pharmacy is in order.

Pharmacists In Action

The role of pharmacist has evolved to meet the increasing health needs of an aging population, safely and effectively manage new medications, ensuring patient safety, and employ innovative technologies. Pharmacists have grown to serve as medical counselors — and they are more than qualified to do so.

All pharmacy students are now required to complete a doctorate program of pharmacy, which provides a more extensive curriculum than the educational requirements of 15 years ago. Many students elect to take additional training in the form of residency programs and expand into deeper clinical focus such as Medication Therapy Management (MTM), medication adherence, patient care coordination and even provide limited prescribing capabilities. 

Technology advances and the expanded role of pharmacy technicians has freed the pharmacist from burdensome administrative duties which previously limited their bandwidth to focus on patients. CerpassRx has found pharmacists’ potential impact on value-based care is immense:

Formulary Development & Management

Healthcare Highways leverages pharmacists to evaluate the safety and efficacy of drugs, as well as analyze the needs of a population. This ensures self-insured employers and their employees get the most value from their pharmaceutical benefit.

Clinical Program Management

As experts in both patient behavior and clinical impact, pharmacists are effective administrators of clinical programs. Healthcare Highways utilizes pharmacists to ensure medication adherence, provide substance abuse prevention, oversee pharmacogenomic testing and more.

Clinical Evaluation

Prior authorization reviews deserve evaluation from a medical expert, which is why Healthcare Highways appoints pharmacists to qualify patients, set medication quantities or, if needed, recommend a modification to their medication treatment.

Drug Intelligence

As active members of the pharmaceutical value chain, pharmacists can monitor the drug pipeline and provide expertise on complex medications. This has been especially valuable to Healthcare Highways as it works to reduce the cost of care associated with high-risk populations, such as diabetics.

Cost Management

CerpassRx uses pharmacists to evaluate therapies and drug lists to provide self-insured employer clients and members with the greatest value.

Pharmacists are not only experts, they are some of the most accessible and trusted healthcare professionals. Their greater involvement in patient care within value-based care models has a positive impact on the health and wellness of patients–and costs.


[1] https://news.aamc.org/medical-education/article/new-aamc-research-reaffirms-looming-physician-shor/


John_Nicolosi_CerpassRx_Rounded

 

John Nicolosi PharmD
Senior Vice President, Chief Clinical Officer; CerpassRX

Dr. Nicolosi’s career began as a Supervisor of Prior Authorization Clinical Operations, followed by Management of several clinical accounts for Catamaran (formerly SXC Health Solutions). Following that he maintained accountability, retention, and growth as a Director of Account Management for the Hospital Segment of OptumRx, before joining CerpassRX as the Senior Vice President of Account Services and Chief Clinical Officer.