Poly-pharmacy Risk Reduction Program

Interested in getting paid for your clinical knowledge? Whether you contract as a pharmacy or a consultant pharmacist (or both), PPRR has opened up new revenue potential for both pharmacists and pharmacies.

The Polypharmacy Risk Reduction (PPRR) program focuses on the MO HealthNet population that is taking 12 or more medications. Patient cases are distributed to participating pharmacies or consultant pharmacists to review the medications and report participant drug therapy related recommendations to the patient’s prescriber.

The primary objective of the program is to identify safety and excess cost issues associated with polypharmacy. Pharmacist payment is based on time spent for billable items including a change in medication due to efficacy, cost or dose; suggesting a lab or discontinuation of a medication; identifying non-adherence, a significant drug-drug interaction, an adverse drug event, or drug-disease interaction.

PPRR: Revenue Potential 

PPRR cases are billed in 15-minute increments at $30, $60, $90, and $120 for a full hour. There is not a limit on billable time spent but, billable time should reflect the intensity of the intervention performed. The average case completion time has been two hours.  Thus, submitting just one case per month, via the STRAND clinical intervention platform, essentially covers the monthly STRAND platform fee. Click here for more information about  STRAND. 

Platform and Direct Secure Messaging Subsidy Available: A $867 Value!

MO-PCN is offering a three-month subsidy on the combined STRAND monthly platform fee and MO-PCN operations and administrative fee, totaling $249 per month. Your total STRAND platform subsidy value: $747.  The first $120 annual Updox fee is also subsidized.

PPRR Program Structure and Outcomes

A face-to-face encounter with the patient is not required for the program, although it is encouraged if possible. Instead, an emphasis is placed on building a relationship between the pharmacist and the participant's physician to utilize a team-based approach to patient care that ultimately results in positive health outcomes for the participant and a reduction in healthcare expenditures in MO HealthNet's pharmacy program.

Outcome measures pertain to 1) changes in the number of chronic medications being taken by the participant; 2) changes in medication cost per member per month (PM/PM) and 3) changes in the number of hospitalizations, re-admissions and ER visits are being tracked. Goals of the program are to ensure that an indication for use exists for each medication, improve medication adherence, and design more balanced medication regimens based upon appropriateness, effectiveness, and safety. 

PPRR Funding:

The Polypharmacy Risk Reduction (PPRR) program is funded through a grant from the MO HealthNet Division (MHD) in cooperation with the Department of Mental Health and the MO Coalition for Community Behavioral Healthcare.

Pharmacist Participation Requirements

Requirements for pharmacist participation in the PPRR program include:

  1. Being a MO-PCN member either as an individual and/or through a business entity (no cost).
  2. Annually renewing the HIPAA Attestation.
  3. Having the MTS designation on your MO Board of Pharmacy license (or working towards).
  4. Completing the PPRR program orientation webinar.
  5. Obtaining an individual NPI number (and business if applies).
  6. Being a MO HealthNet Provider with an active provider status (or working towards).
  7. Obtaining PPRR-specific log-in credentials to access the MO HealthNet CyberAccess E.H.R. web portal
  8. Contracting with the MO-PCN designated electronic platform and direct secure messaging application

Assistance will be provided to you for these items as you progress through program enrollment.

If you are interested in participating in PPRR, please contact Robyn Silvey at [email protected] (573) 636-7522.