Volume XIII, Issue 1
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The MGH Medication Patient Care Assistance
Program: Moving Indigent Care From the Red Into the Black Prescription drug costs have been steadily increasing over the past decade, with numerous newer and more expensive medications reaching the market. At the same time, the number of uninsured patients continues to increase. Although these new drugs may be cost-effective in the long run, their immediate impact can be quite burdensome. According to recent studies, the majority of lower-income patients do not have insurance; therefore, providing them proper health care is difficult.1 Pharmacies with patient care assistance programs now have increased expenditures when they provide prescription medications to this population. Developing a standard formulary system will allow pharmacies to better control drug costs as well as provide pharmaceutical care to the patients in this program. The patient care assistance program at the Massachusetts General Hospital will provide eligible patients medications from a strict formulary at no cost to the patient. The formulary will consist of one or two preferred medications in the major therapeutic areas. A pharmacist will counsel patients upon each new prescription and/or refill. Pharmacists will further educate patients and assess compliance with follow-up phone calls. The expected outcomes are improving medication compliance and an overall reduction in costs for patient care through decreased number of hospitalizations, emergency room visits, and improved disease state management. The Drug Therapy Committee has approved this program. In the next few weeks, the formulary will be made available online for easier access by practitioners. In order to increase practitioner awareness, all pertinent groups will be informed. Our goal is to initiate this program at the Massachusetts General Hospital main outpatient pharmacy and then expand to the other MGH health centers.
Reference: 1. Adams D, Wilson AL. Structuring an indigent care pharmacy benefit program. Am J Health-Syst Pharm 2002; 59: 1669-75.
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The Evidence Is In:
Diuretics Should Be First Choice for Hypertension In case you missed it… The Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was published December 18, 2002, in JAMA (2002:288:2981-2997). This ambitious randomized, double-blind, controlled trial studied the effectiveness of three basic strategies for management of hypertension in 33,357 patients aged 55 and older with at least one coronary risk factor. The winner was diuretics. The patients were randomly assigned to receive a thiazide diuretic (chlorthalidone 12.5 to 25 mg/day); amlodipine (Norvasc; 2.5 - 10 mg/day); or lisinopril 10-40 mg per day, and were followed for 4-8 years. When the outcomes were examined in a variety of ways, there was no evidence that calcium blockers or the ACE inhibitor were better for patients than the diuretic. In fact, there were significantly higher rates of development of heart failure with amlodipine than with diuretics, and higher rates of cardiovascular and cerebrovascular events for patients on the ACE inhibitor. So the conclusion wasn't "a tie." The conclusion of the authors was that diuretics "should be preferred for first-step antihypertensive therapy." Diuretics alone don't work for all patients - about one third of patients at five years need another or a different drug to help control their blood pressure. Still, the findings of ALLHAT are hugely important - and strongly suggest that concerns about metabolic and other side effects of diuretics may have inappropriately led to a decrease in their use. Three specific implications for our management of hypertension:
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