OBJECTIVES: To assess whether enrollment in a pharmacist-led medication therapy disease management (MTDM) program implementing a cardioprotective type 2 diabetes mellitus (T2DM) pharmacotherapy pathway improved HbA1c control, cardiovascular outcomes, mortality, and cost of care.

METHODS: Geisinger implemented an institutional T2DM pharmacotherapy pathway prioritizing cardioprotective medications in 2017. Although the pathway was intended for all prescribers, MTDM pharmacists provided a data-driven, high-touch approach with continuous feedback regarding on-track/off-track prescribing intended to accelerate adoption of protocol-preferred medications. In this retrospective quantitative evaluation, a propensity score-matched (PSM) cohort analysis assessed differences in prescribing of protocol-preferred medications and change in HbA1c between pharmacist-managed patients and usual care after an HbA1c ≥ 9%. A time-dependent Cox Proportional Hazard Model assessed the effect of MTDM enrollment on mortality, and a difference-of-differences evaluation assessed the effect of MTDM enrollment on pharmacy, medical, and total healthcare cost growth.

RESULTS: Among 3,736 matched pairs in the PSM cohort, MTDM-management was associated with a 0.34% greater decrease in HbA1c within one year versus controls (-2.75% and -2.41%, respectively, 95% CI = [-0.44, -0.24], p < 0.0001) and statistically significant increases in metformin, GLP-1 agent, and SGLT2 inhibitor utilization. Adjusted mortality was lower among 9,169 MTDM-managed patients versus 15,638 controls (HR = 0.80, 95% CI 0.73-0.88, p<0.01) over an average of approximately 2.5 years of follow-up. Difference-in-difference analyses demonstrated significantly lower growth in total healthcare costs among MTDM-managed patients in Medicare, Medicaid, and commercial insurance cohorts. For example, in the Medicaid cohort (n = 2,163; 1,080 cases, 1,083 controls), 1-year differences-in-differences for pharmacy, medical, and total healthcare costs were +8.7% (95% CI 2%, 15%), -24% (95% CI -32%, -14%), and -9% (95% CI -14%, -2%), respectively.

CONCLUSIONS: Pharmacist-led implementation of a cardioprotective pharmacotherapy protocol appears to have increased adoption of protocol-preferred medications, improved HbA1c, reduced mortality, and reduced healthcare cost growth.