TRC Conversation: Affordable Clinical Decisions

Jan 8, 2015
Interventions from specialist pharmacists in the Diabetes Therapeutic Resource Center® help patients gain a better understanding of their treatment regimen.
  • Diabetes

What Happened?

A 62-year-old man with diabetes was nonadherent to his oral medication, metformin. He was prescribed an expensive, extended release formulation, which he could not afford.

Clinical Gaps in Care

Metformin is a key medication for a patient with Type 2 diabetes and is the first medication suggested in the American Diabetes Association recommendations to be used in combination with diet and exercise. By not taking metformin, patients reduce control of blood glucose which can lead to eye, kidney and nerve damage and possible cardiovascular issues.

Specialist Pharmacist Intervention

An Express Scripts specialist pharmacist in the Diabetes Therapeutic Resource Center (TRC) reached out to the patient who was not taking his medication and learned this was due to his inability to afford the high copayment. The pharmacist recommended a clinically-equivalent long-acting formulation of metformin that would save the patient more than $1,000 over the course of a year. The pharmacist also offered to contact the prescriber to discuss this alternative solution.

Why It Matters

Being able to afford therapy is an important part of patients maintaining adherence.

Using their extensive knowledge of diabetes medication, Express Scripts specialist pharmacists know which products give patients the best health care value and can speak with prescribers about the clinical equivalency of the different therapy options.

A strong roster of specialist pharmacists focusing on patients with needs in a specific area, such as diabetes, is one of the unique ways Express Scripts helps patients stay on the right treatment and avoid unnecessary, harmful, adverse events. We call it Health Decision Science®: the application of clinical specialization and behavioral sciences combined with actionable data to enable better decisions and healthier outcomes.

Click to download an overview of this conversation.

Author Bio

Lab Staff
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