Sandeep Wadhwa, MD, MBA, Vice President, Care Management Services

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Presentation transcript:

Sandeep Wadhwa, MD, MBA, Vice President, Care Management Services Prepared for the Second National Medicare Prescription Drug Congress

Medicare Part D and Medicare Health Support Designed to reduce Rx costs for low-income seniors Average monthly premiums: $32; annual deductible: $250 Medicare Health Support Designed to improve health and wellness through chronic illness management Co-morbid heart failure and diabetes managed Evidence-based guidelines utilized *“Adding Value to Evidence-Based Clinical Guidelines,” Journal of the American Medical Association. Patrick J. O’Connor, MD, MPH. August 10, 2005. Vol. 294, No. 6. Pp. 741-743.

Evidence-based guidelines: a panacea? Not on their own Review of evidence-based guidelines shows that co-morbid conditions often not taken into account* Co-morbid conditions necessitate multiple medications Non-adherence to medication regimens common Medicare Health Support pilots Manage multiple medications Coordinate management of multiple medications Secure medication information from beneficiaries, provide to PCP Bring in your experience as a geriatrician for bullet #2. What you see in clinic. 68 percent of Medicare budget spent on 23% of beneficiaries with 5+ conditions *“Adding Value to Evidence-Based Clinical Guidelines,” Journal of the American Medical Association. Patrick J. O’Connor, MD, MPH. August 10, 2005. Vol. 294, No. 6. Pp. 741-743.

Medicare Part D Approach to Polypharmacy Formulary control (Bier's list drugs, which have the potential to cause problems in senior population, generally excluded) Medication Therapy Management Program (MTMP) Must be Offered by Part D Plans Beneficiaries with chronic conditions on 5+ medications Reimbursable pharmacist review/counseling Need not (but can) be provided at local level

McKesson Medicare Support Approach Pharmacist review of patients on multiple (9+) medications (including OTC and alternative therapies) or on Bier's list agents Bier's list agents may be appropriate but need review Focus on therapeutic duplication Need for drugs indicated for underlying conditions Drug-drug, drug-disease, drug-food interactions, dose- range checking Direct-to-provider communication when potential issues identified

Questions and comments Thank You. Sandeep Wadhwa, MD, MBA sandeep.wadhwa@mckesson.com