Provision of pain management by a pharmacist with prescribing authority.

Purpose: The clinical and financial outcomes of a pain clinic managed by a pharmacist with prescribing authority are described.

Summary: Pharmacist clinicians in a for-profit, integrated health system recently received permission to bill for their services in certain ambulatory clinics. A pharmacist clinician, who had an individual Drug Enforcement Administration number and whose services are billable under New Mexico law, was chosen to assume the medication management responsibilities in a clinic where 90% of the patient population is treated for chronic non-cancer-related pain. No additional personnel were needed, and no additional space was required, eliminating overhead for the space and utilities needed for operating a new clinic. With the ability to bill for the pharmacist clinician's services, a new model for justification of clinical pharmacy services was developed for the ambulatory care clinics. The revenue generated was tracked by a medical billing system, and clinical outcomes were tracked using the clinic's database for patients' individual visual analogue scale (VAS) pain scores. Between June 2004 and June 2005, an average of 18 patients were seen by the pharmacist clinician each day. The clinic generated 107,550 dollars of actual revenue and saved the health plan over 450,000 dollars. There was a consistent decrease in mean VAS pain scores with continued visits.

Conclusion: Patients with chronic non-cancer-related pain were managed effectively by a pharmacist with prescribing authority and refill authorization in a pain management clinic. The favorable clinical outcomes, revenue generated, and cost savings achieved justified the pharmacist clinician's services in this health system.