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Fortune 500 Employers Set to Launch Aventis-Funded Diabetes Pharmacist Pilot

A new diabetes program set to roll out with specially trained pharmacists.

Five nationally known companies will roll out a diabetes program in 2003 modeled after a successful initiative in Asheville, North Carolina, where specially trained pharmacists have played an instrumental role in helping the city avoid millions in disease-related costs.

The American Pharmaceutical Association's (APhA's) research and educational arm is orchestrating the national pilot with an educational grant from the pharmaceutical giant Aventis.

The project is the first to try to replicate the Asheville model on a national "scaleable" level, said Dan Garrett, the program's project leader. At least 500 diabetic employees are expected to participate across the five as-yet-undisclosed pilot sites, which include several Fortune 500 companies.

"What we're trying to do is figure out how to ramp this up so it can go nationwide," said Garrett, the APhA Foundation's senior director for medication adherence.

Aventis, maker of the long-acting diabetes treatment Lantus (insulin glargine), has not disclosed the amount of the grant. Melissa Feltmann, a spokeswoman for the drugmaker's Bridgewater, New Jersey-based pharmaceuticals unit, said Aventis sees this program as an opportunity to help patients achieve better control of their blood-glucose levels.

More than half of all Americans with diabetes fail to keep to keep their blood sugar in check, she said, a problem that is costing the nation billions in healthcare-related expenditures and lost productivity on the job.

Employers involved in the "patient self-management" program hope to slash those costs and improve the health of their workforce by following Asheville's lead. And if the experiment works, it will help bolster the pharmaceutical industry's argument that appropriate use and management of medications saves the healthcare system money and results in better outcomes.

About six years ago, the city of Asheville embarked on a unique solution to lower medical costs, linking diabetic workers to pharmacists trained in managing the disease. Pharmacists are paid a fee to "coach" patients on diet, exercise and medications, provide foot exams, review glucose-monitor readings and consult with doctors.

It's voluntary program, but Asheville achieves significant compliance by offering to waive the co-payments on disease-specific items, such as insulin and glucose test strips, if patients keep their monthly appointments with the pharmacists. Patients also receive free glucose-monitoring devices.

"It's unbelievable what a difference that leverage has made," said John Miall, Asheville's risk manager and the individual who approved and oversees the program.

The city's medical costs for the average diabetic patient in the program have dropped to $4,651 as of February 2002 from $6,127 before the program's launch in February 1997. Patients' blood-sugar levels also have dropped, and the number of sick days they take has declined.

At the outset, architects of the Asheville project had hoped to realize some statistical reduction in healthcare costs. "Nobody predicted or expected the immediate short-term improvements that we saw," said Miall.

While Asheville's diabetes project has expanded to include 98 patients at present, it is still a relatively small population from which to draw broad conclusions. But Miall is hopeful that other employers across the country will achieve similar results.

With the start-up grant from Aventis, APhA is putting together materials and tools for the five self-insured employers to use in starting their own programs. Two employers are launching the programs in January, with others to follow in March and April.

"These employers recognize that the current healthcare system is not working and they looked at what happened at Asheville and they said, 'Hey, we want to try that too,'" said Garrett, the project director.

As the pharmacy dispensing process becomes increasingly automated, pharmacists are seeking to expand their role in the healthcare continuum. The Asheville project is unique because it is one of only a few in the country through which pharmacists get reimbursed for consulting with patients.

"What this model does is create an opportunity for pharmacists to use the skills they're learning in school and get paid for it," Garrett said.

DID YOU KNOW:

In 2000, the five countries with the highest diabetes prevalence in the adult population were Papua New Guinea (15.5 %), Mauritius (15.0 %), Bahrain (14.8%), Mexico (14.2 %) and Trinidad & Tobago (14.1 %). International Diabetes Federation, 2000.