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APhA DRUG UTILIZATION REVIEW SUBSIDIARY TARGETING MEDICAID AGENCIES

Executive Summary

APhA DRUG UTILIZATION REVIEW SUBSIDIARY TARGETING MEDICAID AGENCIES and third-party prescription drug plans for its drug utilization review (DUR) services, the American Pharmaceutical Association announced July 3. The wholly-owned subsidiary -- Quality Assurance (QA), Inc. -- will market the Drug Utilization Review Program nationwide. Developed by the Iowa Pharmacists Association (IPA) and the Iowa Foundation for Medical Care (IFMC), the DUR program will be marketed through state pharmacy associations to state Medicaid agencies and third-party insurers as a way to enhance patient care and control drug costs, QA said. QA, IPA and IFMC jointly own Drug Utilization Review Systems, which comprises both the software developed by IPHA and IFMC and the entity that will be involved in future software development. APhA Exec VP John Gans said the association views the DUR business as a way to "enhance patient care, save money and elevate the public's awareness of the pharmacist's knowledge of medication use." The Iowa DUR program, which has been in operation since 1984, has resulted in "$3 in direct savings for every $1 invested," according to Thomas Johnsrud, president of the Iowa Pharmacists Association's for-profit subsidiary, PNI (Pharmacists Network of Iowa) Inc. An example of cases in which the program has saved state Medicaid expenditures involves the identification of patients who receive multiple regimens from several physicians and pharmacies. Johnsrud will become president of QA, Inc., which will be based in Des Moines and provide the DUR service nationwide. PNI will continue to market its services within Iowa. The staff of PNI and QA currently are the same. In forming QA, APhA has purchased the management services of PNI. IPA, IFMC and APhA began negotiations last September and established an agreement in principle on May 1. At that time, the first client outside Iowa, Maryland Blue Cross/Blue Shield, signed up for the program. Under the program, clients will send claims data to QA. The information will be fed through the DUR software, which searches for individual "patient profiles at the highest risk of having some type of medication problem," QA said. Factors include the number of physicians and pharmacists seen by the patient, the number of prescriptions received and the total prescription cost for the patient within a month. The DUR program "has the unique ability of combining medical claims data with pharmacy claims data," APhA remarked. QA prepares a report based on the information, makes recommendations and forwards it to a physician-pharmacist review commission established under QA guidelines within each client's state. The commission analyzes the report, contacts the physicians and pharmacists involved, and monitors their responses and looks for changes in therapy through subsequent checking of patient profiles.

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