Wisconsin Pharmacists Provide Medication Therapy Management Services

Submission Date: May 2021

Entry Type: Case Study

State/Territory Submitted on the Behalf of: Wisconsin

States/Territories Involved: Wisconsin

Funding Source: CDC

CDC Funding:

Yes

CDC Funding (Specified):

(1305) State Public Health

Domain Addressed:

Health Systems Strategies

Public Health Issue:

• Hypertension is a major risk factor for cardiovascular disease, the leading cause of death and disability in Wisconsin.
• Approximately 1.3 million adults in Wisconsin have hypertension and less than half of them have their blood pressure under control.
• Medication helps people control their blood pressure yet only two in five persons in Wisconsin take their hypertension medications as prescribed.
• Team-based care that includes pharmacists specializing in medication therapy management as integral members of the care team is an effective strategy to address barriers to medication adherence.

Program Action:

• The Wisconsin Division of Public Health, Chronic Disease Prevention Program partners with the Pharmacy Society of Wisconsin (PSW) and its initiative, the Wisconsin Pharmacy Quality Collaborative (WPQC). The WPQC seeks to expand team-based care that includes pharmacists to improve medication adherence and engage patients in managing their medications and medication plans.
• WPQC is a network of community pharmacies with certified pharmacists who work in community and clinic settings. The pharmacists are certified to provide medication therapy management (MTM) services to patients. Since 2012 the MTM benefit has reimbursed pharmacists for a variety of services designed to assist members/patients in effectively managing their medications with a goal to improve members’/patients’ health in a cost-effective manner.
• PSW/WPQC has 783 pharmacists, 175 technicians, 177 students certified; 275 pharmacies are accredited.
• Clinical and community-based pharmacists are helping patients meet their blood pressure goals by measuring patients’ blood pressure at the pharmacy and teaching patients how to accurately monitor their blood pressure at home with the overall goal to improve health outcomes.
• Benefits of the PSW/WPQC are:
  • Improved medication use and adherence among participating patients
  • Improved patient safety (identification and resolution of drug-related problems)
  • Decreased hospital readmissions
  • Increased partnership between pharmacists and physicians to improve quality and attain desired performance metrics
  • Reduced health care costs for participating patients and payers

Impact/Accomplishments:

• Since 2012, 126,519 total Level I/Level II MTM services have been provided: 120,872 Level I (intervention-based) services and 5647 Level II (consultative review of overall drug regimen) services.
• The Pharmacy Society of Wisconsin is a key partner with the Wisconsin Division of Public Health, Chronic Disease Prevention Unit work focusing on the Million Hearts Wisconsin and national initiatives, interprofessional education, team-based care, patient self-monitoring of blood pressure, and MTM services medication adherence claims data.
• In a Wisconsin Medicaid analysis (2012 through June 2016) MTM services successfully converted prescriptions from 30 day prescriptions to 90 day prescriptions at 1.5 times the rate of a control group which may result in increased medication adherence rates.
• Evaluation showed a short term increase in Medicaid members’ pharmacy costs. Inpatient hospital costs for MTM recipients were lower on average in the year after the intervention.

Challenges/Lessons Learned:

• PSW remains a national leader in the provision of MTM services and in the number of MTM certified pharmacists, pharmacy techs and pharmacies, despite the changing Wisconsin Medicaid funding structure for MTM services.
• The Pharmacy Society of Wisconsin and its WPQC initiative continue to promote MTM services expansion and to certify pharmacists, pharmacy techs  and pharmacies across Wisconsin.
• Difficulties include remaining in contact with pharmacists; informing pharmacies that the WPQC (MTM) initiative is still operational and PSW continues to provide support.
• Gaining access to Wisconsin Medicaid MTM outcome data, especially data on the return of investment (ROI) for MTM services, has been challenging.

Next Steps:

Through the Wisconsin Divisions of Public Health and Medicaid Services, the Chronic Disease Prevention Unit work with Pharmacy of Wisconsin remains focused on the following:

• Promoting the Million Hearts Initiative, inter-professional education, team-based care, patient self-monitoring of blood pressure, MTM services and medication adherence.
• Continuing to provide pharmacists with current information, training and educational opportunities at their annual meetings, conferences, summits, coaching workgroups, webinars, publications and toolkits on MTM, self-management, adherence, and team-based care services for improved hypertension outcomes.

Program Areas:

Heart Disease and Stroke

State Contact Information:

WI
Rebecca Cohen, MS
Wisconsin Department of Health Services
608-261-7826
rebecca.cohen@wi.gov

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