Work

Cost and utilization outcomes of pharmacist-led medication therapy optimization in a Medicare ACO population

Year: 2026

Type: article

Abstract: Introduction Medication-related problems are a persistent source of avoidable spending among Medicare beneficiaries, presenting an important opportunity to improve the quality of care for seniors and reduce financial burden on the Medicare program. Methods We evaluated a pharmacist-led medication therapy optimization (MTO) program implemented in a Medicare accountable care organization population using a regression-adjusted difference-in-differences design with propensity score matching. The analysis included 1003 treated members and 14 031 matched controls contributing 334 531 member-months of claims data (2022-2025). The MTO program combined pharmacogenomic testing, a nine-vector medication-risk algorithm, comprehensive pharmacist review, and structured recommendations to prescribers. Results MTO participation was associated with a statistically significant reduction in total medical costs (pooled average treatment effect on the treated: −19.4%, −$246 per member per month [PMPM]; P < 0.001). The treatment effect was strongly duration-dependent, growing from −4.7% in the first three months to −31.9% (−$462 PMPM; P < 0.001) beyond nine months of program benefit. All care settings showed significant reductions: inpatient admissions −43.1% (P < 0.001), emergency department visits −41.3% (P < 0.001), and outpatient visits −28.3% (P < 0.001). Conclusion Medication therapy optimization was associated with significant cost savings. Parallel trends validation and a pronounced dose-response relationship support a causal interpretation. Short-duration evaluations are likely to substantially underestimate the full economic value of an MTO program.

Source: Health Affairs Scholar

DOI: 10.1093/haschl/qxag223

Authors: Hazem F Elewa, Joseph F Levy, Chintan Pandya, Steven E Goldberg, Travis A Morgan

Institutions: Ivy Tech Community College of Indiana, Indiana Clinical and Translational Sciences Institute, Johns Hopkins University

Language: English

Topic: Pharmaceutical Practices and Patient Outcomes

Subfield: Geriatrics and Gerontology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,150