What we have found in the industry is that even when medication management services are present, such as those offered by PBMs or disease management vendors, they are often insufficient to adequately address the full-range of medication related problems that exist in chronic care populations.  Deficiencies include, but are not limited to the following:

• Incomplete Data – often medication management services consider a limited set of data – such as pharmacy claims data alone.  A comprehensive solution must include a richer set of data including medical history, health risk assessment data, and the entire medication regimen (not just those pharmaceuticals captured on claims data).  Limited data prevents the identification of the most frequent MRP – untreated symptoms or conditions.  In addition, poor data quality and integrity results in medication profiles that are not actionable.
• Undeveloped Medication Management Tools – often medication management services rely on clinical decision support tools that are inadequate for assessing complex medication regimens that exist in chronic care populations.  These tools may include something basic like industry standard drug utilization review software or may only review targeted therapeutic classes (e.g., a behavioral health intervention that only reviews behavioral health medications).  Comprehensive medication management services such as those offered by excelleRx review the entire medication regimen and consider non-medication clinical factors as well to ensure the recommendations are whole-person and comprehensive.
• Lack of Focused Skill Set – care management generally depends upon a nurse-centric business model.  However, optimal medication management requires doctorate level clinical pharmacists that have received specialized training.  These are the healthcare professionals that members and physicians look to when seeking medication related advice.  In addition, these professionals are best equipped to understand the complex medication regimens that exist in chronic care populations.