title: Prevalence of drug-related problems and cost-savings opportunities in medicaid high utilizers identified by a pharmacist-run drug regimen review center.
abstract: BACKGROUND
  Despite numerous reports of state Medicaid drug utilization review (DUR) programs, little data are available about the prevalence of drugrelated problems (DRPs) in Medicaid patients. A university-based, pharmacist-run DUR program for high utilizers was created as an alternative to imposition of a statutory limit of 7 medications per month in the Utah Medicaid program in 2002. The DUR program was designed to suggest ways that high-utilizing patients could decrease their total number of medications to 7 or fewer prior to imposition of the 7-medication limit at some time in the future.
  
  
  OBJECTIVE
  To describe the experience in 1 Medicaid DUR program and to report the prevalence of DRPs and cost-saving opportunities (CSOs) among a population of Medicaid recipients who were high utilizers of prescription drugs.
  
  
  METHODS
  DRPs were identified by 5 clinical pharmacists employed by the Drug Regimen Review Center (DRRC) in Salt Lake City. The purpose of the center was to provide drug therapy review services for a select number of Utah Medicaid recipients (200-300 per month) who exceeded a 7-medication limit during the calendar years 2003 and 2004.
  
  
  RESULTS
  Out of 391,890 eligible Medicaid recipients, 242,411 (62%) received at least 1 medication, and 16,958 (4.3%) exceeded the 7-medication limit during the review period. Of those exceeding the limit, the DRRC reviewed a total of 3,706 (21.9%) patients, representing the highest utilizers by volume of medication. The prevalence of DRPs considered clinically important in the review cohort was 79.7% of patients, including therapeutic duplications in 54.6% of patients, dose form optimization in 29.7%, and inappropriate uncoordinated care in 25.3%. The average pharmacy cost per month for patients with at least 1 DRP was 1,081 dollars; by contrast, the average pharmacy cost per month for all other patients receiving at least 1 prescription was 91 dollars.
  
  
  CONCLUSIONS
  Approximately 4% of Medicaid recipients exceeded the 7-medication monthly limit. Among the 22% highest utilizers in this group, 48% of nursing home residents and 87% of ambulatory recipients had at least 1 DRP, or an overall rate of 80% of high-use Medicaid recipients or as much as 3.2% of the Medicaid population.
authors.affiliation: Drug Regimen Review Center, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA. joanne.lafleur@pharm.utah.edu
authors.forename: Joanne
authors.initials: J
authors.lastname: LaFleur
authors.forename: Carrieann
authors.initials: C
authors.lastname: McBeth
authors.forename: Karen
authors.initials: K
authors.lastname: Gunning
authors.forename: Lynda
authors.initials: L
authors.lastname: Oderda
authors.forename: Carin
authors.initials: C
authors.lastname: Steinvoort
authors.forename: Gary M
authors.initials: GM
authors.lastname: Oderda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D010593:Pharmaceutical Services; D019338:Polypharmacy; D014589:Utah