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Revised January, 2010 CONFIDENTIAL AND PROPRIETARY - page 29 / 31

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CONFIDENTIAL AND PROPRIETARY

and McLeod’s lists, as well as using prescribing information specific to the elderly, to outline medications with the highest risk of potential harm to the member (e.g., dicyclomine – a medication with uncertain effectiveness and strong anticholinergic properties, which are poorly tolerated in the elderly). Pharmacists will receive a notification that one of their patients is currently taking an IMIE medication and prompt them to call or fax the physician to request a safer prescription medication.

Compliance and persistency (C&P): These interventions are designed to promote patient adherence to medication regimens as prescribed by their physician. There are two types of compliance and persistency interventions:

  • Type 1 – Pharmacists are notified when a prescription is processed for a patient who is new to therapy for that particular drug. The pharmacist then provides new- to-therapy compliance counseling while dispensing the medication. The pharmacist should address any questions or concerns that the patient may have, specifically those pertaining to adherence to their medication regimen.

  • Type 2 – Patients who are fourteen days late or who have not yet refilled their medication are identified through this intervention. Patients should be contacted for a consultation to discuss the importance of being compliant and pharmacists should offer to refill the patient’s medication. Additionally, if refill-reminder programs are offered, benefits of these programs should be explained to patients seeking assistance.

Polypharmacy: Pharmacists at our MTM Clinical Care Center (CCC) utilize the Medication Appropriateness Index (MAI) assessment questionnaire developed by Fitzgerald, et al., a widely recognized tool used to guide the evaluation of a patient’s medication therapy. CCC pharmacists use the MAI to review the member’s medication regimen to identify opportunities for possible interventions. The patient’s prescribing physician is then contacted to discuss the proposed changes in medication therapy. A polypharmacy intervention package is then sent to the patient’s primary pharmacy. The package contains all approved recommended changes in therapy. The pharmacist should call the patient’s physician to verify the changes in therapy and to obtain valid prescriptions for new therapies. After approval by the physician, the pharmacist should set up an appointment with the member to review their medications and changes in therapy. If the physician does not agree with the recommended changes in therapy, the pharmacist will document this in the feedback form and submit it at the time of reimbursement. To support the consultation, all members undergoing a polypharmacy review are provided with a Personal Medication Record (PMR) as well as a Medication Action Plan (MAP) that includes a full description of their medications, including appearance (e.g., color, shape, dosage form) and directions on how best to take the medications (e.g., time of the day, with or without food).

Member Access to MTM Services

When they become eligible for MTM services, members may receive a telephone call from their local pharmacist to participate in a one-on-one review and discussion of their medications at their local pharmacy. Pharmacist-directed consultations should provide

Walgreens Health Initiatives – Pharmacy Manual

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