An evaluation of the effects of policy changes on pharmacy participation in the Wisconsin Medicaid Pharmaceutical Care Project

Background. The Wisconsin Medicaid Pharmaceutical Care Project (WMPCP) began July, 1996, providing pharmacists financial incentives for pharmaceutical care services given to Wisconsin Medicaid fee-for-service recipients. There have been two major changes in the WMPCP. A point-of-sale (POS) system was adopted in September, 1999, allowing pharmacists to submit pharmaceutical care (PC) claims electronically rather than submitting paper claims; in February 2001, Wisconsin Medicaid began using prospective drug utilization review (PDUR) designed to identify Medicaid patients' drug therapies problems for pharmacists. Theoretically, POS can potentially reduce barriers to submitting PC claims for pharmacists; PDUR increases pharmacists' awareness of drug therapy problems increasing awareness of opportunities for PC services.;Objectives. The primary objective was to evaluate the effects of POS and PDUR on: (1) the number of participating pharmacies in the WMPCP; (2) the number of paid PC claims; and (3) the composition of the reason and level codes for paid PC claims. The secondary objective was to explore whether pharmacy type, location, and the volume of Medicaid prescriptions were associated with outcome measures.;Methods. The study was conducted in a retrospective, interrupted time series design and used administrative datasets for evaluation. A total of 1,848 Wisconsin Medicaid pharmacy providers during state fiscal years 1997 and 2003 were the study population.;Results. POS and PDUR had no immediate effects on the number of participating pharmacies per month and the number of PC claims per month. However, POS showed sustained, positive effects on these two outcome measures, and PDUR showed a sustained, negative effect on the number of participating pharmacies. After implementation of POS and PDUR, more claims were submitted by pharmacists for the reason Drug Use: Patient Behaviors, and more claims were associated with shorter service time (6-15 minutes). Pharmacy type, location, and the volume of Medicaid prescriptions were pharmacy characteristics significantly associated with the number of participating pharmacies and the number of PC claims.;Conclusions. The findings suggest that POS and PDUR had significant effects on pharmacy participation in the WMPCP. More research can help understand whether and how pharmacy participation in PC services can be promoted to a higher level.