Impact of a Pharmacy Liaison-Managed Care Model within a Health-System on Clinical and Economic Outcomes in Patients with Diabetes

Diabetes is a growing chronic health problem that can contribute to long-term microvascular and macrovascular complications, poor health outcomes, and increased total medical expenditures. Patients with diabetes face numerous challenges, including medication affordability issues, barriers to adherence, and the complexity of managing their disease. Systematic reviews show widely variable adherence rates to both insulin and oral antidiabetic drugs, ranging from 36% to 93%. The impact of pharmacist-led services on diabetes outcomes is well documented, however limited evidence supports the effect of pharmacy liaisons on challenges faced by patients with diabetes. The objective of this quality improvement initiative was to establish a pharmacy liaison-managed care model for patients with diabetes and to measure its impact on medication access, adherence, and changes in hemoglobin A1C (HbA1c).

Methods:

An integrated model for the medication management of patients with diabetes was designed and implemented within target adult and pediatric endocrinology clinics at a health-system specialty pharmacy (HSSP). In an effort to minimize common barriers to timely therapy, liaisons investigated patient pharmacy and medical benefits, completed prior authorizations, and identified financial assistance. Liaisons coordinated medication and durable medical equipment (DME) fulfillment while ensuring medication adherence during monthly refill calls and served as a bridge to prescribers to escalate clinical issues. Changes in HbA1c were measured starting up to 60 days prior to the patient’s onboarding date, through the following 6 months after enrollment.

Results:

The diabetes care model was successfully integrated in two clinics in March 2019, with 548 total enrollees to date. From October 2020 to September 2021, liaisons completed over 2000 medication prior authorizations for enrolled patients, resulting in an average time to therapy of less than three days. Financial assistance secured through the care model resulted in medication copays with an 85th percentile of $8. Patients achieved high levels of medication adherence, as indicated by an average Proportion of Days Covered (PDC) of 97%. An average 1% reduction in HbA1c was observed in a sample of 82 patients after a minimum of 6 months on service.

Discussion/Conclusion:

Implementation of a pharmacy liaison-managed diabetes care model resulted in positive outcomes for patients as demonstrated by high PDC, HbA1c reductions, time to therapy initiation, and medication copays. The 1% reduction in HbA1c in the study cohort has implications on total medical expenditures. This model can be adapted to other health systems to simplify care and improve health outcomes for patients with diabetes.