Outcomes associated with pharmacist-led diabetes collaborative drug therapy management in a medicaid population

Objectives: Pharmacist-led diabetes collaborative drug therapy management (CDTM) has been shown to improve outcomes. Whether such programmes are effective specifically in Medicaid patients, who face barriers to access and self-management, has not been well characterized. This pilot study explores glycaemic control, utilization and costs associated with pharmacist-led CDTM in a small population of Medicaid patients with type 2 diabetes mellitus (T2DM). Methods: A pre–post, historical cohort study was conducted of patients with T2DM and Medicaid coverage who received pharmacist-led CDTM in community-based primary care clinics between 2008 and 2012. Outcomes included change in haemoglobin A1c (HbA1c), healthcare costs and utilization. Results: This study included 79 Medicaid patients with T2DM who received pharmacist-led CDTM. A subset of 46 patients with Medicaid coverage through an affiliated Medicaid Plan, Healthy U, was identified for additional analysis. At 6-month follow-up, HbA1c was a mean (SD) of 2.0% (2.0) lower than the baseline of 10.3% (1.7). Primary care clinic encounters increased by a mean (median) of 3.4 (2) visits. Per patient health system charges increased by a mean (median) of $4392 ($620), and the amount paid by Medicaid in the Healthy U subset was $822 ($68) higher in the follow-up period. Conclusion: A pharmacist-led diabetes CDTM intervention was associated with improved glycaemic control in Medicaid patients, which corresponded with a higher number of primary care visits and observed costs. These findings are consistent with studies not limited to Medicaid, suggesting that CDTM can be effective in type 2 diabetes patients with Medicaid coverage.