ORGANIZATION: Walgreens Health Services. PROBLEM OR ISSUE ADDRESSED: Approximately one-third of the elderly population is at risk for polypharmacy and its complication. Polypharmacy increases patients’ risks for many ill effects, including drug interactions, non-adherence, hospitalizations, morbidity and mortality. GOALS: The WHS Polypharmacy MTMP is designed to ensure optimum therapeutic, clinical and financial outcomes by promoting proper prescribing and improving patient medication use. Three polypharmacy cases were examined to illustrate the process of polypharmacy intervention process and how such interventions may help reduce healthcare expenditures. OUTCOMES ITEMS USED IN THE DECISION: a) Drug therapy outcomes: reduction in drug interactions and therapeutic duplications, ensuring appropriateness of medication therapies and improved compliance and persistency; b) Literature-based clinical outcomes: reduction in the incidence and severity of adverse events including falls and fractures, hospitalizations, nursing home admissions, morbidity and mortality; c) Financial outcomes: pharmacy and medical cost savings. IMPLEMENTATION STRATEGY: 1) Identify polypharmacy MTMP candidates based on number of disease states, number of maintenance medications and estimated yearly drug spend; 2) Enroll polypharmacy MTMP candidates according to program specification (Opt-in or Opt-out model). 3) Review member medication profiles by pharmacists at the MTM clinical call center, utilizing a Medication Appropriateness Index. 4) Contact the prescribing physician to discuss the identified medication-related issues and recommend possible therapeutic solutions. 5) Document the results of the clinical intervention and fax/mail a copy of the Medication Action Plan (MAP), Personal Medication Record (PMR) and dosing calendar to the participant’s community pharmacist and/or patient; 6) Counsel patient on therapy changes and proper medication use. 7) Follow up on polypharmacy intervention outcomes. RESULTS: Case One: Ten medications were intervened upon by MTM call center pharmacists after a patient’s medication history was reviewed. Specific interventions accepted by the prescriber included: combining multiple medications to a single medication for the purpose of decreasing pill load; generic substitution to reduce cost; reducing dosage to help ensure safe dosage in the elderly; discontinuing duplicated medication. Assuming all medications were maintenance medications and the patient would be in full compliance with the recommended medications for the next 12 months, the total pharmacy saving for this case would be $4,413 per year. Case Two: Six medications were intervened upon by MTM call center pharmacists after a patient’s medication history was reviewed. Specific interventions accepted by the prescriber included: combining multiple medications to a single medication for the purpose of decreasing pill load and discontinuing medication due to duplicate therapy. Assuming all medications were maintenance medications and the patient would be in full compliance with the recommended medications for the next 12 months, the total pharmacy saving for this case would be $1,019 per year. Case Three: A patient was identified as HIV positive through drug inference and confirmed by the physician. MTM call center pharmacists recommended adding an NRTI in accordance with national guidelines. MTM pharmacists also noticed the patient was noncompliant with his lipid lowering therapy, Tricor, and recommended promoting proper use of this medication. The total added drug cost from these recommendations would be $3,695 per year. However, incorporating the NRTI into the drug therapy could result in $10,000 per year savings in medical cost in accordance with literature. In this particular case, the net savings in overall healthcare expenditures could be $6,305 per year. Overall, the WHS polypharmacy MTMP identified 359,124 Medicare Part D members eligible for the program in 2006. However, only about 5% of the qualified members were enrolled in the program largely due to the chosen opt-in program design. The WHS polypharmacy MTMP provided appropriate therapy recommendations to the patients’ physicians, addressed compliance and persistency issues, and optimized drug therapy. Drug therapy outcomes have been improved by ensuring efficacy and minimizing toxicities through decreasing the number of drug conflicts (e.g. drug interactions, duplicate therapy). According to literature, clinical outcomes may be improved as a consequence of this intervention. In addition to bringing better health outcomes, the WHS polypharmacy MTMP could also reduce both pharmacy and medical healthcare expenditures. LESSONS LEARNED: The WHS Polypharmacy MTMP participation rates varied by the plan design. Overwhelmingly, those plans with a polypharmacy MTMP opt-out design had a much higher patient participation rate in comparison to plans with an opt-in design (82.26% vs. 4.43%). Possible reasons for the low member participation rate in the opt-in model include members having difficulties understanding the benefits and opt-in invitations being discarded with the materials that members did not see as pertinent.