Medication Management for Special Populations

UMass Medical School’s Clinical Pharmacy Services provides pharmaceutical care coordination for more than 600 medically fragile Massachusetts children under age 22, all members of Massachusetts Medicaid’s MassHealth program. After visiting a child’s home and reviewing the list of drugs, which can include more than 20 individual medications, our team makes recommendations to optimize drug therapy and improve quality of life.

Our efforts result in a $4 savings for each $1 the state spends on the program.

Improving care and quality of life

Before Clinical Pharmacy Services began providing this medication management service, it was sometimes a challenge for families to obtain the medications their children needed.

Our specialized pharmacy staff provides assistance through several avenues:

• Helping families obtain and understand their children’s medications
• Streamlining the prior authorization process for medically necessary drugs, including those needed for rare conditions and palliative care
• Evaluating drug regimens during home visits and physician appointments
• Identifying and managing drug interactions and side effects
• Improving clinical outcomes and quality of life by optimizing dosing and monitoring medication adherence
• Determining which alternative medications would be effective and covered by MassHealth

Lowering MassHealth costs

Our pharmacists work collaboratively with the child’s medical providers. Because we forge close relationships with doctors who treat children in this population, we often become a resource for the physicians as well. When doctors implement our recommendations for therapy modification, it can have a significant result — for example, decreased nursing hours due to reduction in medication administration times or nursing interventions.

Ensuring that these children receive the appropriate medications lowers MassHealth’s costs by accomplishing the following:

• Reducing emergency room visits
• Avoiding unnecessary hospitalizations and outpatient visits
• Facilitating hospital discharges
• Managing primary insurer identification and third-party liability
• Decreasing overall medication use
• Assuring access to medically necessary medications
• Avoiding  medication-related adverse effects, drug interactions, and drug–disease interactions