CCNC clinical directors chose pharmacy as a quality improvement and cost-containment effort to begin in fall 2002. Their decision was influenced by the following utilization data:

• Pharmacy costs have had the greatest increase in expenditures for N.C. Medicaid overall and for the Community Care of North Carolina (CCNC) networks.
• Pharmacy expenditures have increased approximately 37% in a 12-month time frame.
• There are a high number of N.C. Medicaid enrollees on eight (8) or more prescriptions each month.
• The pharmacy initiative provides an opportunity to improve quality and reduce costs.
• Polypharmacy (taking an unusually high number of prescription medications) can be a problem, because the more medications a person takes, the greater chance for drug interactions and adverse effects.