The Right Drug for the Right Resident: 5 Practical Strategies for Long-Term Care Pharmacies to Improve Outcomes

Residents in long-term care (LTC) settings often manage complex medication regimens alongside multiple chronic conditions, functional limitations, and changing clinical needs. As drug pricing policies evolve and out-of-pocket barriers continue to shift—particularly through Medicare Part D—LTC pharmacies have a growing opportunity to move beyond cost-driven substitution and prioritize “best-option” therapies: the medications you would confidently choose for your own family member to maximize safety, effectiveness, and quality of life.

In an APEX Live panel focused on ensuring the right drug for the right patient in LTC, pharmacy leaders shared practical, field-tested approaches that help consultant pharmacists and LTC dispensing teams overcome long-standing hurdles such as formulary constraints, prior authorization friction, and operational inefficiencies. The message was clear: Age-friendly pharmacy care is not about adding complexity—it is about being intentional, aligning medication decisions with what matters to the resident, and building sustainable processes for high-quality care.

Below are 5 strategies to implement that approach.

1. Make medication regimen reviews a “change engine,” not a checkbox.

Comprehensive medication regimen reviews (MRRs) are among the strongest levers LTC pharmacies have to identify risk, improve outcomes, and standardize prescribing. Panelists emphasized using structured tools—such as the American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults and STOPP/START (Screening Tool of Older Persons’ Prescriptions/Screening Tool to Alert to Right Treatment) criteria—to consistently flag high-risk medications and provide opportunities for safer, more effective alternatives.

In practice, this means using the review to do more than identify issues: It should trigger a repeatable recommendation workflow that supports prescribers and facilities in acting on what the pharmacist finds. Beyond medication risks, the review process can also uncover barriers to real-world use—especially swallowing difficulties, tolerability issues, and formulation mismatches that drive nonadherence or unsafe administration.

Implementation tip: Build the MRR/Medication Management Review (MMR) workflow to automatically prompt 3 checks.

• High-risk medication screen (anticholinergic burden, sedatives, duplications)
• Function/tolerability screen (mentation, mobility, swallowing)
• Prevention opportunities (vaccination gaps, fall-risk contributors)

2. Reduce anticholinergic burden by making safer overactive bladder therapy the default pathway.

Few medication classes illustrate the gap between cheap and best more clearly than anticholinergics—especially for overactive bladder (OAB). The panel highlighted that agents such as oxybutynin (Ditropan; Janssen Pharmaceuticals, Inc) are still widely used despite well-established risks in older adults, including cognitive effects and increased vulnerability to adverse events.

A practical alternative is shifting toward β3 agonists that offer efficacy without the same anticholinergic burden. Importantly, the panelists also highlighted this as a clinical and operational win: Reducing adverse outcomes, such as falls, can decrease downstream use, and choosing a clinically superior therapy supports an age-friendly standard of care.

Panelists also pointed to a reality that LTC teams know well: Payer systems often push older options because they are inexpensive. But the panel argued that the industry has not applied the same force toward safer prescribing, even when better therapies exist and are increasingly accessible.

Implementation tip: Set up a step pathway for OAB.

1. Start with behavioral strategies when appropriate (eg, bladder training)
2. If medication is needed, try to avoid anticholinergics in older adults
3. Opt for β3 agonists when clinically appropriate
4. Use comorbidity considerations and documentation to support the choice

3. Treat formulations as a safety intervention, especially for dysphagia.

In LTC, the “right drug” is only part of the equation. The panel stressed that residents frequently face swallowing challenges, and the wrong dosage form can lead to aspiration risk, administration errors, nonadherence, or unsafe manipulation of medications.

One panelist noted that roughly 50% to 60% of nursing home residents may have swallowing difficulties, making formulation optimization a core LTC pharmacy function—not a niche workflow. The discussion highlighted the value of sprinkle capsules, liquids, and other alternative formulations that can improve tolerability without compromising release mechanisms.

This matters because crushing or splitting certain products can alter pharmacokinetics, create inconsistent dosing, or increase adverse effects, issues that can be especially consequential in frail older adults. In contrast, purpose-built alternative formulations can reduce the administrative burden on nursing staff and help facilities avoid avoidable clinical events.

Examples discussed included the following:

• Metoprolol succinate extended-release (ER) sprinkle formulations (to preserve ER properties)
• Rosuvastatin sprinkle formulations (avoiding unnecessary tablet manipulation)
• Duloxetine delayed-release sprinkle capsules (maintaining delayed-release design)

Implementation tip: Make dysphagia/formulation review a standard admission checkpoint and ensure facility documentation supports medical necessity.

Correct documentation can also align care planning and reimbursement models when swallowing limitations increase required care intensity.

4. Build a pharmacy-led vaccine program that closes gaps and captures value.

Vaccination remains one of the most actionable preventive care services in LTC, yet logistics, documentation gaps, and staff burden can limit uptake. The panel made the case that LTC pharmacies are uniquely positioned to lead immunization programs because they can provide the following:

• Assessment at admission (identifying vaccine gaps early)
• On-site clinics in key seasons
• Administration support, including consultant pharmacist involvement
• Reliable documentation, including entering records into state immunization information systems (IIS)

Beyond outcomes, panelists emphasized that vaccine programs can also strengthen pharmacy sustainability through billing for vaccine product and administration. This creates a meaningful service line that complements traditional dispensing reimbursement.

A key operational challenge discussed was IIS fragmentation across jurisdictions. The practical takeaway: Do what you can in the systems you can access and recognize that incomplete records are common. The panel also pointed to immunize.org as a useful source of concise, science-based patient and staff education materials.

Implementation tip: Use a “3-touch” model.

1. Admission vaccine assessment embedded in MRR/MMR
2. Seasonal clinics scheduled with facility leadership buy-in
3. Catch-up doses administered during routine consultant pharmacist visits

5. Use indication-first antipsychotic selection, and move away from “bucket” prescribing.

Antipsychotic use in LTC carries clinical, regulatory, and reputational complexity. The panelists stressed that responsible care requires 2 commitments at the same time:

• Deprescribe when medication is not needed
• When it is needed, ensure the resident receives the right medication for the specific condition, rather than a generalized “antipsychotic” approach

The discussants acknowledged that older antipsychotics historically transformed care but also reinforced how broad, nonspecific use can lead to avoidable adverse effects and suboptimal outcomes. Panelists argued that as diagnostic specificity improves—moving beyond broad categories such as “dementia”—therapy selection should become more precise.

Panelists highlighted that in Medicare Part D, antipsychotics fall under a protected class, meaning plans generally must cover a broad range of agents rather than forcing a single drug. That framework can help LTC teams navigate utilization management and support indication-driven selection.

Implementation tip: Pair antipsychotic stewardship with documentation discipline.

• Clarify the underlying condition driving symptoms
• Document nonpharmacological approaches and why medication is needed
• Align agent selection to the most appropriate evidence/indication profile
• Monitor tolerability, mobility, and mentation impacts over time

Making “best option” care operational and sustainable

A core theme of the panel was that age-friendly pharmacy care is not only clinically sound, it can also be operationally sustainable. The speakers repeatedly returned to the idea that LTC pharmacies should not be forced into a “cheapest-at-all-costs” identity, particularly when safer, more effective therapies and preventive services can reduce the total cost of care and protect the resident’s quality of life.

Across deprescribing, safer therapeutic substitution, formulation optimization, vaccines, and targeted therapy selection, the path forward looks similar: Build consistent workflows, document clinical need, and partner closely with facilities and prescribers so the “right drug” becomes the default, not the exception.

When medication choices reflect what you would want for your own family member, everyone wins. Residents experience better outcomes, facilities strengthen care delivery, and pharmacies create the stability needed to keep providing high-value clinical services.

REFERENCE

APEX Live: Ensuring the right drug for the right patient in long-term care pharmacies. American Society of Consultant Pharmacists. February 24, 2026. Accessed February 24, 2026. https://www.ascp.com/events/EventDetails.aspx?id=2027167