December 29, 2007 
I am sure that some people are focused on this, but I rarely hear about it. Although most people go to more than one pharmacy, today’s claims adjudication systems are programed to identify serious issues across pharmacies. But, since you can’t reject every claim, the edits in the system are focused on the serious issues which might leave some opportunity for improvement. If you add in OTCs and supplements that people take, there may be opportunities that aren’t captured by the system.
I found some results from a 2003 Premera BC program which I thought were quite impressive. They built a program that offered a medication review with your physician if you took 5 or more prescriptions. Their results included:
- 50 percent of the targeted members brought in their medications for the physicians to review.
- One out of every three members received prescription changes.
- Sixty four percent had a medication added.
- Forty seven percent had one or more medication stopped.
- Sixty five percent had the dosage of a medication changed.
Given results like this, it would seem like a program everyone should be doing.
Enabling Healthy Decisions 
George,
Interesting. Thanks for your blog. I still have my reservations about the completeness of claims. They seem to wobble around a lot in the first few weeks (meds aren’t picked up, they are changed, etc) and I am not sure the low-cost generics always hit the radar screen. Are you aware of any studies in that area?
Mark Frisse