Hossam Maksoud, PharmD

Nine in 10 adults 65 years of age and older would prefer to remain at home versus living in an assisted living facility or nursing home, according to a study by 

. However, due to a variety of physical and/or cognitive impairments, it becomes unsafe for many adults to remain at home as they age.

Poor medication adherence is one of the factors that threatens safety among this population. Studies have shown that medication adherence is common among older adults for various reasons, including forgetfulness, inability to afford medications, a lack of motivation, medication adverse effects, a complex medication regimen, distrust of physicians and/or diagnoses, or a misunderstanding of physicians’ instructions. But poor adherence to medication can worsen seniors’ health conditions and lead to serious complications, as well as decreased quality of life and functional ability.

Pharmacists can play an important role in helping ensure compliance with prescribed medications, which can help seniors maintain their health and quality of life while aging at home. The role of a pharmacist includes improvising technology to track when patients are running low on medication and in need of refills, as well as communicating with patients and physicians when refills are needed.

Often, patients wait until the last minute and cannot get to the physician in time to ensure uninterrupted doses of their prescription. The role of a good pharmacist is to coordinate and manage the timing of refills to prevent this from happening.

Compliance packaging, which helps patients adhere to their medication regimen, is particularly important in the senior population. Putting all the drugs a patient takes in a single package, such as blister packs or pouches, and organizing them by day and time of day helps prevent doubling up on medication or missed doses.

Our pharmacy also finds that reconciling patients’ medications is helpful in ensuring compliance. Many older adults take multiple medications, and we don’t want the patient to run out of their needed medications every few days. Therefore, we reconcile them to a schedule in which patients get all their drugs at the same time every month.

The transition of a patient home from a hospital or skilled nursing facility is an especially stressful time for medication adherence. Patients may leave the facility with several new prescriptions, some of which go unfilled for reasons typically related to lack of insurance coverage or the patient’s inability to pay. Patients may forego the new medications and find old meds at home and take those instead of what was prescribed—and these old meds may have been part of the reason they ended up in the hospital in the first place.

As pharmacists, we must always check the patient’s medication history and confirm that the drugs prescribed in the hospital should be taken in addition to the patient’s existing prescriptions. A pharmacist can prevent errors by questioning any discrepancies and contacting physicians’ offices if there is any duplication of therapy or adverse interactions between existing and new medications.

As continuing care is very important when the patient leaves a skilled nursing facility or hospital, our pharmacy takes patients through a 90-day continuum of care program, in which we monitor them closely. We know that patients who make medication mistakes at this time can wind up back in the hospital.

By following up and communicating with patients through telepharmacy, we help ensure they are stable by inquiring if there are any problems with their medications, such as untenable adverse effects or high costs. We monitor the medication supply to see how many doses the patient has on hand and to determine when refills will be needed.

This is part of how the pharmacist can monitor compliance—if the remaining supply is much lower or higher than expected, this could indicate that the patient has missed doses or incorrectly doubled up on meds.

By communicating with patients and their family members, we can find out whether there are medications that are too expensive and beyond their ability to afford. The pharmacist can problem-solve by communicating with the physician to find alternative drugs, as well as work with the insurance company.

Insurance companies often require that the patient take certain steps, such as trying less expensive drugs, before it will approve a medication. When the insurance company’s policies are impeding the patient’s medication adherence, pharmacists must advocate on behalf of the senior.

Our pharmacy also communicates with seniors through our relationships with adult daycare centers. The centers may have our pharmacist come once a month to answer questions from patients and family members about medication and related topics.

For example, some patients have questions about surgical supplies, such as whether they are covered by insurance and where to order them. The pharmacist may meet with 30 to 40 patients at the facility, who can show the pharmacist the medications they have in their bags, make sure there’s no duplication, and reconcile the medications for them.

By proactively monitoring medication compliance among our senior clients, pharmacists can contribute in a real way to the ability of older adults to remain in the community.

Hossam Maksoud, PharmD, is president, founder and chairman of Community Care Rx, a unique long-term care pharmacy with offices in Hempstead, NY, and Totowa, NJ, which provides comprehensive pharmacy services to various types of organizations.

Articles

Pharmacists can play an important role in helping ensure compliance with prescribed medications, which can help seniors maintain their health and quality of life while aging at home. 

How Pharmacists Can Help Seniors Age in Place 

More than one-third of adults reported that their health insurance plan would not cover a drug prescribed by their physician over the past year, according to an NPR poll.

 Upon learning of an insurance company’s denial of coverage for a medication, the patient may become stressed and may also be surprised by this occurrence, leading them to potentially take out their anger on the pharmacist or pharmacy staff they are speaking to.

In this situation, the first step a pharmacist should take is to address the customer’s expectations, which may be based on a lack of information. Many patients may expect that they will receive the drug their doctor prescribes without any complications, and that their insurance will cover the cost of the drug with no obstacles. But more often than not, that isn’t how it works at all.

It is important to educate patients that insurance companies typically have formulary drugs, both generic and brand-name. Within their formulary, insurance companies will have both preferred and non-preferred lists, which will have different co-payment requirements. Once the patient understands this, it is possible to work with them and the physician to assess the best way to proceed.

If there is an alternative drug within the same therapeutic class that would be covered by the customer’s insurance, it is possible to call the physician to suggest it. In many cases, the doctor may decide to try the alternative drug.

However, there may be cases in which the physician may say the patient needs the uncovered drug—perhaps the formulary alternative drug was previously prescribed and did not produce the desired result. Whatever the conversation and decision by the physician may be, the pharmacist is the one who will need to be able to communicate this information to the patient because it is crucial to keep the patient in the loop regarding their health care protocol and requirements.

Additionally, it may be beneficial to work alongside the physician’s office to initiate the prior authorization process to impress upon the insurance company that the drug in question is medically necessary. For pharmacists, making sure the prior authorization process keeps moving along is important as well.

As pharmacists know, prior authorization is not a simple process and it is not uniform across insurance companies. Some companies require more documentation than others and it is a pharmacist’s job to invest in staff who will spend the time to follow up with the insurance company.

This task it vital to find out what else is required and whether there is anything outstanding to coordinate with the physician’s office and ensure the missing documents are submitted in a timely manner. If the prior authorization process is completed and the drug is still denied, it may be necessary to discuss with the physician and the patient whether they want to go through the appeal process.

Naturally, prior authorization takes time—usually several days, at least—and during this time the patient will not be able to take their prescribed medication. As a pharmacist, it may be necessary to opt to let the patient pay out of pocket for 2- or 3-days’ worth of medication while waiting for the decision.

In many instances, this option may not be feasible, such as with inhalation, topical, or ophthalmic drugs or injectables. Some pharmacies may also dispense a couple days’ worth of medication at no charge until the prior authorization is granted, but they run the risk of incurring costs if they get a denial. 

This is a risk that some pharmacies are willing to take to ensure their patients are happy and healthy. However, it also can be possible to approach this situation by convincing the insurance company to authorize an emergency supply of a few days’ worth of drugs while the decision is pending.

Sometimes drugs are covered, but at a high out-of-pocket cost to patients. When patients are on maintenance drugs that cost $75 per month, for example, this is not a sustainable cost for many patients. At Community Care’s specialty pharmacy division, we provide specialty drugs in several categories, including rheumatology, dermatology, osteoarthritis, and hepatitis, and many of these drugs have high out-of-pocket costs.

As a pharmacist, it is important to educate patients about the process for obtaining a specialty drug. Many of these medications have no substitutes or alternatives and almost all have high co-pays.

Customers should not hesitate to let their physician know when drugs are beyond their reach in terms of expenses. With specialty drugs, the prior authorization process requires much more documentation and may take longer to complete. In addition, some of these medications will have limited distribution, whereby the drug can only be dispensed by a few particular pharmacies nationwide.

When it comes to cost or co-pays, there are nonprofit organizations that assist low-income individuals with medication expenses. Many biopharmaceutical companies have been expanding their cost-sharing programs in which they help cover out-of-pocket expenses for patients who cannot afford their medications. In addition, some manufacturers offer free trials, which may be a more affordable option for patients.

Furthermore, patients with high out-of-pocket expenses may also realize significant savings by enrolling in a prescription discount card program. As a pharmacist, it may be beneficial to proactively look for coupons and assistance programs and navigate through them for patients to provide the support they may not be able to get anywhere else.

Since pharmacy is, at its heart, a service business, the required process of communicating and educating customers, working closely with physicians, and navigating relief programs offered by manufacturers and nonprofit organizations may help to provide customers with the solutions they need to address the problems and stress of receiving a denial by their insurance company for drugs they may need to maintain their health.

Hossam Maksoud is CEO and founder of Community Care Rx, a unique long-term-care pharmacy based in Hempstead, NY, that provides comprehensive pharmacy services to various types of organizations.

Neighmond P. When Insurance Won't Cover Drugs, Americans Make 'Tough Choices' About Their Health. NPR.org. January 27, 2020. Accessed July 14, 2021.

Since pharmacy is a service business, the required process of communicating and educating customers, working closely with physicians, and navigating relief programs can help patients customers address the problems and stress of receiving a denial by their insurance company.