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Health Net Medication Therapy Management Program Helps Chronically Ill Medicare Members Improve Prescription Drug Use


Program’s 90 Percent Participation Rate Exceeds 65 Percent National Average; Program Garners Industry and Agency Recognition

LOS ANGELES. - Health Net Pharmaceutical Services (HNPS), the pharmacy benefit management subsidiary of Health Net, Inc. (NYSE:HNT), today released the results of a study showing that its Medication Therapy Management (MTM) Program in 2008 reached 90 percent of Health Net’s eligible Medicare Part D members. According to the Centers for Medicare and Medicaid Services (CMS), the national participation rate in similar free, voluntary MTM programs was 65 percent. As a result of the program’s success, CMS recently selected Health Net as one of only 10 Medicare Part D sponsors to participate in a pilot program to perform in-depth analysis on MTM outcomes.

Health Net’s innovative program helps its Medicare Part D members who have multiple chronic diseases and multiple chronic medication prescriptions to improve how they take their drugs and potentially decrease their pharmacy expenses.

In 2008, Health Net enrolled approximately 90,000 members in its program. Of the more than 162,000 drug related problems (DRPs) identified, the pharmacists intervened in approximately 50,000 to increase taking medication regularly, 45,000 to explain potentially adverse drug interactions, 44,000 to reduce cost of care, 20,000 to fill gaps in care with their doctor, and 3,000 to stop duplicate drug therapy.

“Our program provides a comprehensive approach for effective and safe medication treatments that lead to positive medical outcomes and economic value for our members,” said Virginia E. White, Pharm.D., FCSHP, senior vice president and chief clinical officer of HNPS. “It presents an entire picture of a patient’s health because we not only involve the member but the many individuals who may help them – their caregivers, physicians and pharmacists as well as our pharmacists and care coordinators.”

HNPS MTM Program Overview

HNPS pharmacists review up to 5,000 member profiles weekly for potential DRPs including noncompliance, gaps in therapy, drug interactions, and contraindications, as well as opportunities to reduce members’ out-of-pocket costs by taking generics or formulary alternatives to treat their cholesterol, blood pressure, diabetes, allergies, acid reflux, and other ailments. The pharmacists send letters with this information to encourage members to call HNPS and speak with one of its MTM pharmacists, and to bring the letters to their next doctor appointment. The pharmacists also discuss the DRPs with their colleagues at Managed Health Network (MHN), Health Net’s behavioral health subsidiary, for potential psychosocial intervention. Serving as “health coaches,” the pharmacy and behavioral health clinicians talk with members about MTM and mental health services available to them. These issues range from addressing mental health concerns to physician searches, adult day care, weight loss, and smoking cessation.

A Partner You Can Trust: Health Net Goes Beyond CMS Minimum Requirements

HNPS chose to go beyond the minimum CMS guidelines to help provide the peace of mind to more members that they are safely taking the right prescription drugs for their medical conditions. In addition to integrating MHN’s behavioral health services into the program, HNPS chose to widen eligibility criteria to members with three or more diseases who take five or more drugs, and changed from opt-in to opt-out membership to extend services to more members. HNPS pharmacists also built an internal, web-based software application to review members’ drug history profiles, maintain records and generate communications. The application’s ease of use, accuracy and efficiency has enabled HNPS to offer services beyond minimum CMS requirements.

CMS requires all insurers offering Part D plans to also offer a free and voluntary MTM program to their eligible members who have multiple chronic diseases, take multiple drugs and are likely to incur at least $4,000 in annual pharmacy costs.

“I commend Health Net for developing an MTM program that promotes the appropriate use of medications and reduces the risk of potentially adverse events associated with medications among the Medicare population who we serve,” said Sally Heckman, R. Ph., Pharmacy Services manager for the Delmarva Foundation for Medical Care (DFMC) and the Delmarva Foundation of the District of Columbia (DFDC), CMS’ Quality Improvement Organization (QIO) for Maryland and the District of Columbia. “I also applaud Health Net for working with other QIOs to increase the level of drug safety in their elderly Medicare populations.”

Since 2006, HNPS has collaborated with QIOs representing 12 states and the District of Columbia, sharing its pharmacy claims data to help them ensure effective and safe medication treatments for the elderly.


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