Pharmacists Essential to Mitigating Financial Risk From High-Cost Medications: Caroline Vovan, PharmD, CDE

In the third and final part of her interview with The American Journal of Managed Care^®, Caroline Vovan, PharmD, CDE, director of ambulatory care pharmacy at the Providence Clinical Network in California, discussed how ambulatory clinical pharmacists support medication optimization and adherence.

She also emphasized the importance of involving pharmacists in contracting and negotiation processes, as their familiarity with the treatment options and their pricing can help secure more cost-effective agreements.

Vovan explored these topics further during her presentation, "How Ambulatory Clinical Pharmacy Is Essential in a Value-Based Care Health System," at the Institute for Value-Based Medicine^® (IVBM) event held in partnership with Providence on July 9.

Revisit parts 1 and 2 to learn more about the role of ambulatory clinical pharmacists in value-based care models and how they help improve outcomes while reducing health care costs.

Transcript

Can you expand on how ambulatory clinical pharmacists support medication optimization and adherence, particularly for high-risk patient populations?

The highest-risk patients are those patients where we've seen the highest hospitalization rates, patients having heart attacks, congestive heart failure, [and] stroke. Those are the types of medications that we're targeting. The health plans are rightfully doing that, too, and CMS is doing that, as well.

Looking at diabetes medications, looking at ACE and ARBs, which are [angiotensin-converting enzyme] inhibitors and angiotensin receptor blockers, and also statins. Those are the types of medications that have been proven to keep patients out of the hospital.

Fortunately, we get information—lists, every single week—of patients whose medications need a refill. We get thousands in a week. We do use technology and texting to be able to remind them, "It looks like you've got a medication that is due for a refill. Make sure that you do get it refilled and you don't get any lapses on it, or else you're missing medication." So, those lists really help.

Looking ahead, what innovations or trends in ambulatory clinical pharmacy do you expect to have the biggest impact on value-based care?

Traditionally, we think of ambulatory clinical pharmacy as the disease management part of things. Although it still makes a huge impact on our physicians and our patients, I think we could do more than that.

At Providence, we have a lot of departments now with an ambulatory clinical pharmacy. That has a lot to do with population health and, more pertinently, financial costs. With the rising cost of medications, as pharmacists, we need to be more on the contracting side, in front of the health plans, so that our health system does not become blindsided by high-cost and pipeline medications that are really, really expensive now. Our financial people are just not aware of how much these things cost now.

As pharmacists, we know the cost, and our health systems are oftentimes at a loss because they did not negotiate enough to even cover the cost of the medications, not to mention all the staffing and overhead that is involved. I think, as pharmacists, we can really help with the contracting and the pricing of all of those negotiations.