Pharmacist Prescribing for BP Control Makes Economic Sense

An economic analysis found that pharmacist prescribing of antihypertensive medications could save the country over a trillion dollars — if only limitations on pharmacist reimbursement could be removed.

The long-term prevention of cardiovascular events associated with a pharmacist-led intervention to improve blood pressure (BP) control was estimated to give each person 0.34 additional life years and 0.62 additional quality-adjusted life years, translating to $10,162 in cost savings per person over a 30-year time horizon.

If mass uptake reached 50% of the population, this would mean $1.137 trillion in hypothetical cost savings and an estimated 30.2 million life years saved over 30 years, according to researchers led by Dave Dixon, PharmD, of Virginia Commonwealth University School of Pharmacy in Richmond.

“These findings suggest that a pharmacist-prescribing intervention to improve BP control may provide high economic value,” the study authors reported in JAMA Network Open. “Our analysis showed that a pharmacist-prescribing intervention would remain cost-effective if pharmacists received a hypothetical reimbursement of $100 for the initial visit and $50 for each follow-up.”

Dixon’s group said that the U.S. has all the tools and resources to implement pharmacist-prescribing interventions except for reimbursement. All but one U.S. state legally allow pharmacist prescriptive authority in collaboration with physicians.

“While pharmacists may participate in collaborative models, pharmacists are infrequently recognized by payers because they are not recognized clinicians under the Social Security Act. Pharmacists can bill for services incident to those provided by a physician or advanced practice clinician; however, this is limited to Level 1, which is only $23.10 for 5 minutes of clinical services and insufficient for the level of service provided,” the authors noted.

“While some states have recently passed clinician status legislation, much work remains to ensure pharmacists are adequately compensated for the clinical services they provide,” the researchers stressed.

Dixon’s team highlighted some evidence of a “critical need” for innovation in BP control.

One estimate found a 23.1% increase in hypertension-related mortality in the U.S. from 2010 to 2019, which had disproportionately affected Black people. What’s more, the “worsening shortage of primary care clinicians” could mean between 7,800 and 48,000 fewer providers by the year 2034.

“Pharmacists are well placed in the community to screen and manage HTN [hypertension] because they see patients up to 10 times more frequently than physicians,” the group argued. “Expansion of prescriptive authority for pharmacists could increase access for those with limited or no source of primary care, which disproportionately affects males, underrepresented minorities, the uninsured, and those living in the southern U.S.”

Dixon and colleagues had their economic analysis based on the RxACTION trial, spanning 2009 to 2013, which compared a pharmacist-prescribing intervention against BP education and usual care. The main finding of that trial was the intervention group’s significant lowering of BP and better achievement of target BP.

In the economic model, the population was assumed to have a mean age of 64 years, with 49% men and a mean baseline BP of 150/84 mm Hg.

Over the 30-year time horizon, the pharmacist-prescribing intervention yielded 2,100 fewer cases of cardiovascular disease and eight fewer cases of kidney disease per 10,000 patients.

The estimated event rate and cost savings rely on several assumptions, the investigators acknowledged, including high uptake of the pharmacist prescribing in the real world. They added that the findings cannot be generalized to the pregnancy population, nor do the results take into account telehealth practice.