Tori Erxleben-Rush, PharmD

More than ever, physicians are pushing for a transition to care models that incentivize fewer, more effective treatments. This kind of innovative thinking should also exist in the pharmacy space, helping to frame the way we handle multiple-drug regimens. A look at our current health care landscape illustrates this need.

We’re seeing massive growth of enrollment in special needs plans—up 32% over the past 10 years

—indicative of an increasingly medically complex and socially vulnerable population. The continued growth of that population will add pressure to an already struggling health care system.

Currently, 67% of older Americans experience polypharmacy, using 5 or more medications a day.

 Over the next 10 years, projections anticipate 4.6 million largely preventable medication-related hospitalizations of Americans over 65 years of age.

This isn’t just a problem for patients—suboptimal medication use is costing the country billions of dollars every year. A 2018 study estimated that the annual cost of drug-related morbidity and mortality resulting from non-optimized medication therapy was $528.4 billion.

Unfortunately, the traditional pharmacy model has tended to focus on the volume of dispensed medications, diminishing pharmacists’ opportunity to provide comprehensive pharmacy care. The prescription fulfillment practices that accompany this model reduce time that could be spent conducting comprehensive medication reviews, counseling patients, or addressing cost and other barriers to optimized use of medication therapies.

The result of these practices can lead to unchecked circumstances of polypharmacy, low adherence to prescribed medications, and an increased risk for unwanted interactions between drugs. As we look toward a post-pandemic health care system, improvements are required to remedy these concerns, and they need to be focused on challenges related to care quality and cost.

Predictive analytics and robust patient data can mitigate some of these issues. Many patients are medically complex, on too many medications they don’t fully understand, or are on multiple medications that risk avoidable interactions.

When we accumulate these data with a comprehensive list of the current and past patient medications, we can formulate the most effective medication regimens by quality and cost, where possible, to help patients get on and stay on the right medications.

However, these advancements aren’t possible until we better integrate the pharmacist into the patient’s care journey. When pharmacists are involved in the care process, they can address common barriers to medication use, such as polypharmacy, ineffective medication, high costs, health and lifestyle considerations, and social needs. Integrated care that leverages the benefits that the pharmacist can offer is key to ensuring person-centric care.

The timing is right to advance practices that emphasize pharmacy care management, especially as we witness an increase in patients relying on their pharmacists to educate them about their medication regimens and disease states in the wake of the COVID-19 pandemic. This is not a call to shift from traditional dispensing entirely, but rather a push for more robust involvement among pharmacists to address the unique needs of medically complex and vulnerable patients who may require additional services.

, we have worked successfully with medically complex, socially vulnerable patients and their prescribers to mitigate a wide range of social determinants of health and other barriers that prevent proper medication use and optimal outcomes. We first complete a comprehensive interview in which we can address concerns around care coordination, health literacy, and medication cost. In addition, we take this time to identify any potential red flags in existing prescriptions so we can prevent potential hospitalizations from medication interaction.

We have seen that when pharmacy services take the time to address long-standing adherence barriers such as transportation and patient education—capabilities that go above and beyond traditional medication dispensing—we can meaningfully improve individuals’ medication use and, ultimately, their health outcomes. This is the goal of pharmacy care management.

But this process doesn’t end with the dispensing of medications. Patient communication should be consistent after the medication has been dispensed to ensure the patient continues to understand their medication and treatment plan and address additional barriers to proper medication use as they arise. The availability of pharmacy care management services is not only key to improving medication adherence, polypharmacy, and the rising costs of health care in this country, but it is also integral to improving health at the community level.

Our public health is only as good as the health of our most vulnerable patients. When we can make these interventions and solve the issues that cause decreased quality and medication use, we are strengthening the health of the entire population and our health systems. By pivoting our care models to not only allow for, but encourage the delivery of pharmacy care management programs, we are addressing fundamental issues with medication use and strengthening 

patients and stakeholders in the country’s health system.

Tori Erxleben-Rush, PharmD, is director of Clinical Pharmacy Programs at RxAnte.

Medicare Advantage in 2021: Enrollment Update and Key Trends

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Articles

When pharmacists are involved in the care process, they can address common barriers to medication use, such as polypharmacy, ineffective medication, high costs, health and lifestyle considerations, and social needs.