Clinical pharmacy services can significantly help curb prescription drug spending 
and other healthcare costs, according to a new study. According to the University 
of Illinois at Chicago, for every dollar spent by hospitals and health systems to 
provide clinical pharmacy services, $4.81 was saved by the resulting lower drug 
costs, reductions in adverse drug events and medication errors, and other 
savings. 

The researchers examined 93 studies on clinical pharmacy services from 2001 
through 2005. “This is pretty consistent with the savings we have seen in 
previous years. Over time, regardless of the kind of clinical pharmacy services or 
the patients served … you see this savings,” said Glen Schumock, a senior author 
of the study and director of UIC’s Center for Pharmacoeconomic Research. Most of 
the studies took place in hospital pharmacies. However, many were also 
conducted in ambulatory care clinics, physicians’ offices, and in community 
pharmacies. “A higher proportion of these studies are coming from settings other 
than hospitals in recent years. It shows that other facilities are offering these 
services,” Schumock said.

The services in the study included general pharmacotherapeutic monitoring 
services, target drug programs, and disease state management services. In nearly 
70 percent of the studies (about half of the 93 were studied by the researchers 
because of their economic focus), a positive economic benefit was associated 
with clinical pharmacy services. Most of the savings resulted from direct medical 
costs, such as lower drug costs and lessening patients’ hospital stays or doctor 
visits. 

The Centers for Medicare & Medicaid Services (CMS) launched the Medicare PHR 
Choice Pilot in Arizona and Utah.  This pilot program will offer beneficiaries with 
Original Medicare the opportunity to choose one of the personal health record 
(PHR) products offered by the companies selected for the pilot. PHRs will allow 
beneficiaries to maintain their health record information electronically and Medicare 
will add claims data directly to the PHRs for this pilot. PHRs are tools that can help 
consumers keep track of information that will make it easier to manage their health 
and health care services.  A PHR is a record of health information that is under the 
control of the consumer.  Sometimes it only contains data entered by the 
individual, but it can also include information from his or her provider or from a 
health plan – as in this pilot, where, if the consumer requests it, Medicare will 
transfer health information from its claims database directly to the individual’s PHR. 

Through this pilot, beneficiaries who select one of the PHRs offered by the 
participating PHR vendors can choose to add additional personal health information 
to supplement the information provided by Medicare. Depending on the specific 
product, beneficiaries may be able to authorize links to other personal electronic 
information such as pharmacy data.  PHRs also may offer links to tools that help 
consumers manage their health, such as wellness programs for tracking diet and 
exercise, information about medicines and medical devices, health education 
information, and applications that detect potential medication interactions.   
Beneficiaries can elect to allow family members, health care providers, or 
whomever they choose to have access to their PHR.  This access can allow 
caregivers to help manage a loved one’s health or provide information that could 
be important to a physician caring for you in an emergency.

More information about the Medicare PHR choice pilot can be found on 
www.medicare.gov

More Americans are burdened by chronic illnesses such as diabetes and high blood 
pressure, often having more than three at a time, and this has helped fuel a big 
rise in out-of-pocket medical expenses. With prescription drugs playing a key role, 
average annual out-of-pocket medical costs -- those not covered by health 
insurance -- rose from $427 per American in 1996 to $741 in 2005, researchers 
wrote in the journal Health Affairs. 

The findings were based on nationally representative surveys of about 32,000 
people in 2005 and 22,000 people in 1996.  Adjusting for inflation, that translated 
to 39 percent more in out-of-pocket spending per person over that time, 
according to Kathryn Paez of Maryland-based health research organization Social 
& Scientific Systems Inc. and colleagues. The figures were much higher among the 
elderly. For example, a person insured through the Medicare program for those 65 
and older who had three or more chronic conditions paid an average of $2,588 of 
out-of-pocket medical expenses.

Based on government survey data, 44 percent of Americans in 2005 had at least 
one chronic medical condition, which could include diabetes, high blood pressure, 
high cholesterol levels, cancer, arthritis, heart failure and others. That compares 
to 41 percent in 1996. The study did not look directly at the causes of the 
increases, but there appear to be several factors.  The rise in Americans with 
multiple chronic illnesses comes as obesity and sedentary lifestyles have grown 
more common. Obesity contributes to many chronic ailments including diabetes. 
U.S. health officials say the rate of new cases of diabetes soared by about 90 
percent in the past decade.  The percentage of Americans with three or more 
chronic illnesses rose even more sharply. It jumped from 13 percent in 1996 to 22 
percent in 2005 for ages 45 to 64, to 45 percent for ages 65 to 79, and rose from 
38 percent to 54 percent for those 80 and older. Among all ages, it went from 7 
percent in 1996 to 13 percent in 2005.  Chronic disease accounts for three-
fourths of the more than $2 trillion spent on health care yearly in the United 
States. The chronic disease increase was seen not just among the very oldest 
age groups but also in middle age and early old age -- regardless of sex, race, 
ethnicity and income level.
(Source: Reuters; Tuesday, January 06, 2009)

In this study of community-dwelling older adults, prescription and nonprescription 
medications were commonly used together, with nearly 1 in 25 individuals 
potentially at risk for a major drug-drug interaction. 

Design, Setting, and Participants:  Three thousand five community-residing 
individuals, aged 57 through 85 years, were drawn from a cross-sectional, 
nationally representative probability sample of the United States. In-home 
interviews, including medication logs, were administered between June 2005 and 
March 2006. Medication use was defined as prescription, over-the-counter, and 
dietary supplements used "on a regular schedule, like every day or every week." 
Concurrent use was defined as the regular use of at least 2 medications. 

Results:  The survey response rate was 74.8%.  Eighty-one percent used at least 
1 prescription medication, 42% used at least 1 over-the-counter medication, and 
49% used a dietary supplement. Twenty-nine percent used at least 5 prescription 
medications concurrently; this was highest among men and women aged 75 to 85 
years.  Among prescription medication users, concurrent use of over-the-counter 
medications was 46% and concurrent use of dietary supplements was 52%.  
Overall, 4% of individuals were potentially at risk of having a major drug-drug 
interaction; half of these involved the use of nonprescription medications. These 
regimens were most prevalent among men in the oldest age group and nearly half 
involved anticoagulants.  No contraindicated concurrent drug use was identified. 

Conclusions:   In this sample of community-dwelling older adults, prescription and 
nonprescription medications were commonly used together, with nearly 1 in 25 
individuals potentially at risk for a major drug-drug interaction. 
[Source JAMA. 2008; 300(24):2867-2878.]