EFFECT OF A PHARMACIST-EDUCATION INITIATIVE ON KETOROLAC USE AND COSTS IN A MEDICAID PROGRAM

The effects of a pharmacist-education initiative on the use and costs of ketorolac in a state Medicaid program are reviewed. An intervention letter describing changes in the manufacturer's prescribing guideline s for ketorolac and providing suggestions for interacting with physici ans regarding the use of ketorolac was sent to 150 of the 301 pharmaci es that participate in New Mexico's Medicaid program. The remaining 15 1 pharmacies served as a control group. Ketorolac claims records for t hree months before and after the intervention were reviewed. The mean quantity of ketorolac tablets, total days' supply, and number of presc riptions filled per pharmacy per month were calculated for both period s. The number of prescriptions not filled as a result of the intervent ion as well as the number that could have been avoided, the number of cases of peptic ulceration (ketorolac's major adverse effect) that wou ld be avoided, and the associated cost savings if all the state's Medi caid pharmacies had been included in the intervention were estimated. A total of 167 pharmacies (90 intervention and 77 control) dispensed k etorolac for Medicaid patients during the study period. Ketorolac disp ensing rates declined during the postintervention period in both the i ntervention group and the control group, but the reduction was greater in the intervention group. It was predicted that if all pharmacies we re included in an intervention, 135.6 fewer prescriptions for ketorola c would be filled each year; as a result, 1.14 cases of peptic ulcerat ion would be avoided and net Medicaid costs would be reduced by $1638. Sending educational letters to pharmacists was associated with a mode st reduction in ketorolac use in a state Medicaid program; a net reduc tion in Medicaid costs if the intervention were extended to all pharma cies that participate in the state's Medicaid program was projected.