A Pharmacist-Led Model of Medication Management Service Integrated with Critical Illness Insurance Program Review: A Prospective Evaluation in Non–Small Cell Lung Cancer

Background Non–small cell lung cancer (NSCLC) is a leading cause of cancer incidence and mortality worldwide. Targeted therapies have improved outcomes, yet challenges remain, including poor adherence, drug-related problems (DRPs), and inadequate management of adverse events. Meanwhile, the critical illness insurance program (CIIP) alleviates financial burdens but is often misaligned with rational clinical drug use. Pharmacist-led medication management services (MMS) have shown value, but their integration with insurance review in oncology care is underexplored. Objective To establish and evaluate a pharmacist-led MMS model integrated with a CIIP review for patients with NSCLC, aiming to optimize drug use, enhance outcomes, and promote cost containment. Methods Pharmacists collaborated with CIIP reviewers to provide MMS for insured patients receiving EGFR-TKIs, ALK-TKIs, or multitarget TKIs. Clinical outcomes, DRPs, quality of life (QoL), and healthcare costs were assessed. Statistical analyses were performed via SPSS 20.0, with paired t tests and Kruskal–Wallis tests applied. Results A total of 248 patients with advanced NSCLC were enrolled. At study completion, 168 patients achieved stable disease, 6 achieved partial remission, 32 discontinued therapy, and 26 died, yielding a disease control rate of 70.16%. At baseline, 305 DRPs were identified (mean, 1.23 per patient), nearly half (49.84%) of which involved medication safety and 34.10% adherence. By the end of the study, the number of unresolved DRPs had decreased to 48 (mean, 0.25 per patient). Over one year, patients’ QoL scores improved significantly [80 (72–92) vs. 112 (93–122)]. Pharmacist involvement in MMS and CIIP reviews generated estimated savings of 2.08 million CNY in direct medical costs. Conclusions This prospective evaluation demonstrated that a pharmacist-led MMS model integrated with a CIIP review reduced DRPs, improved adherence and QoL, and enhanced disease control while achieving substantial cost savings. The findings highlight the potential of combining pharmaceutical care with insurance oversight to achieve rational drug use and financial sustainability in oncology, with important clinical and policy implications for broader adoption.