Professor Leslie Shimp Leads U-M Focus on Medicines Initiative

W ith more than 80,000 employees, retirees, dependents, and survivors covered under the U-M prescription drug plan, the University is faced with a large and growing healthcare commitment.

To enhance health and reduce costs for plan enrollees, the University launched the Michigan Healthy (MHealthy) Community program in 2004. Its goal: to make the U-M community healthier through innovative programs that encourage healthful behavior and work practices.

The most recent phase of this initiative, MHealthy: Focus on Medicines, began this spring when letters were mailed to adult U-M prescription drug plan members who have nine or more active prescriptions funded by the drug plan. (Research shows that, nationwide, 4.3 percent of all Americans — nearly 13 million people — take eight or more medications, and 7.7 percent take six or more.) Additional drug plan letters will be mailed monthly over the next year.

The letters included a personalized list of each person’s prescribed medicines, along with other information, such as how much the individual and U-M have paid for their medicines in recent months. All of the recipients will also receive written information about how they could save money, and some will also receive an invitation to speak by phone with a U-M pharmacist about ways to cut costs. Either way, recipients will learn about options such as pill-splitting and switching to generic medicines or medicines that are on the U-M drug plan’s less-expensive “preferred” drug list.

Later this spring, some letter recipients will receive an invitation for a face-to-face Comprehensive Medication Review (CMR) with a U-M pharmacist. Using the person’s prescription drug list, their nonprescription drug, herb, and supplement list, and their U-M health records, U-M pharmacists will look for opportunities to improve the safety and effectiveness of treatments (e.g., possible drug interactions, more effective or safer alternatives, and opportunities to add other preventive drugs or to reduce the number of medicines).

“This project is unique because it targets all beneficiaries who take multiple medications of any kind, for a broad range of medical conditions,” says Professor of Pharmacy Leslie Shimp, BSPharm’74, PharmD’, MS, who leads the project.

The program has been designed to rigorously assess and compare the effects of the different approaches: letters, costonly conversations with pharmacists, and CMRs.

“This approach will allow us to evaluate the program’s effects during the pilot phase, and to guide possible future expansion of the program,” says Duane M. Kirking, PharmD, PhD, director of the College’s Center for Medication Use, Policy, and Economics (CMUPE). CMUPE will evaluate the program. “Our objective evaluation can then be used by U-M to improve the program, and by other employers and insurers interested in offering similar programs.”

Focus on Medicines is being funded by the U-M Office of Human Resources and Affirmative Action, which administers the U-M prescription drug plan through a contract with SXC Health Solutions, Inc. Although the Focus on Medicines project will include adults with any medical condition, the evaluation will concentrate on costs and health issues of those with asthma, chronic pain from osteoarthritis, diabetes, high blood pressure, high cholesterol, and osteoporosis. These conditions, and others such as GERD, chronic acid reflux, depression and hypothyroidism, are prevalent among people who take multiple medications. Patients often have more than one medical condition and may receive prescriptions from multiple doctors who specialize in the treatment of a particular disease.

“With every medicine that’s added, every disease that’s diagnosed, and every additional provider involved in a patient’s care, the risk of duplication, interactions between medications, or problems with dosing increase, and opportunities to save money may be overlooked,” says Shimp. “Add in the fact that many patients never tell their primary care providers about which nonprescription medicines, herbal supplements, vitamins, and minerals they take, and the risk of a problem is even more likely.” At the same time, U-M Medical School studies show that out-of-pocket cost can make a big impact on patients’ decision to fill a prescription and take medicine on schedule — which can affect their health.

“This has been a team effort from inception to launch, and will remain a team effort throughout,” Shimp adds. “Many Michigan- affiliated pharmacists have been involved and will remain involved in this project. In addition to Duane Kirking and me are Assistant Professor of Social and Administrative Sciences Suzan Kucukarslan, PharmD; CMUPE Assistant Research Scientist Jeff Ellis, PharmD, MS, PostDoc’ Clinical Assistant Professor Hae Mi Choe, PharmD; Clinical Associate Professor Tami Remington, PharmD’ Clinical Assistant Professor Trisha Wells, PharmD’ and Nancy J.W. Lewis, PharmD’, MPH, associate director and associate research scientist, CMUPE. We also consulted with Amy Guenette, PharmD’, who is a clinical assistant professor at the University of Illinois College of Pharmacy.”

E-mail: lshimp@umich.edu, dkirking@umich.edu, skucukar@ umich.edu, jeffel@umich.edu, haemi@umich.edu, remingtn@umich. edu, tdwells@umich.edu, njwlewis@umich.edu.