Pharmacy Cost Reduction Strategies: Comprehensive Medication Management
Managing prescription drugs is complex and confusing for most employees. With doctors oftentimes solely focused on treating specific conditions or disease states, they don’t always take the person’s full medical history and up-to-date medicine list into account. Meanwhile, people have little education on drug types, uses and side effects unless they have a medical background.
These factors are the perfect storm for medication mismanagement. Medication mismanagement is common (so common that it accounts for half a trillion dollars in waste annually) and comes in a variety of forms, like duplicate therapy, adverse drug reactions and non-adherence.
Comprehensive medication management educates members on medications (e.g. prescription, nonprescription, supplements, herbals), reduces pharmacy costs and contributes to long-term health improvements.
The Challenge of Managing Prescription Drugs
Polypharmacy and the Complexity of Managing Multiple Medications
Polypharmacy is the use of many medications at the same time by one person. Managing chronic conditions often entails a complex medication regimen with multiple medications from various doctors. This fragmented approach can result in a lack of coordination among healthcare providers. Each doctor may be unaware of the full spectrum of medications their patient is taking, leading to potential conflicts or redundancies in treatment.
Patient Use of Multiple Pharmacies
Patients may obtain their medications from multiple pharmacies, primarily influenced by their insurance plan but also factors like price and location.
Additionally, mail order pharmacies are growing in popularity. This may be more cost-effective than retail pharmacies and more convenient for individuals, like those who cannot drive. However, this also means the patient is not having an in-person interaction with a pharmacist.
Patient use of multiple pharmacies is a problem with coordination of care. Different pharmacies may not have access to the patient’s complete medication profile, leading to heightened risk of adverse drug interactions, as well as challenges in adhering to complex medication schedules.
Patients find themselves at the center of this fragmented system, burdened with the responsibility of managing complex medication lists. This includes navigating different dosing schedules, understanding indications for medication use and appropriate administrations (e.g. with or without food, evening dose due to drowsiness effects). The complexity of this task cannot be overstated, especially for those dealing with multiple health issues.
The disarray in medication management has significant economic consequences. It is estimated that more than half a trillion dollars ($528B) are lost annually due to mismanagement of prescription medications, which is equivalent to 16% of total US healthcare expenditures. The leading factors contributing to this include non-adherence to medication regimens, inappropriate dosing, adverse drug reactions, unnecessary or redundant therapy, and inadequate treatment strategies.
The current state of the pharmacy ecosystem for employees with chronic conditions is marked by a lack of coordination, leading to both health risks for the patient and substantial economic costs. Addressing these challenges requires a more integrated approach to medication management, involving pharmacists who are most qualified to support these patients.
What is Comprehensive Medication Management (CMM)?
Comprehensive Medication Management examines a member’s medications (including prescription, nonprescription, vitamins, herbals, supplements, etc.) and determines “that each medication is appropriate for the patient, effective for the medical condition, safe given comorbidities and other medications being taken, and able to be taken by the patient as intended”.
CMM is patient-centered and proactive. This approach to medication management ensures safe, effective, and coordinated care that enhances the health and well-being of the member. Each patient receives a personalized plan and follow-up to monitor outcomes.
The goals of CMM are to reduce medication-related problems (MRPs) and improve patient outcomes. For Goodpath members, Comprehensive Medication Management looks like:
The first step of CMM is an in-depth pharmacist consultation. The pharmacist and member meet to review a member’s current medications, which may include prescription drugs, over-the-counter drugs, supplements, herbals, as well as their lifestyle factors.
During this consultation, the pharmacist is looking to assess:
Does the patient have an indication for the medication?
Is the medication appropriate for the condition being treated?
Are there any medication related problems that are addressable during the consultation?
The pharmacist also considers the patient's treatment history, any social determinants of health (SDOHs), previous adverse reactions, medication adherence history, and any subjective concerns the patient may have.
The pharmacist then conducts a thorough review of the information provided. They are focused on identifying any interactions that might affect the member's health. They are looking for drug-drug, drug-disease, and drug-food interactions.
In addition, the pharmacist considers relevant patient information, including patient demographics, medical and immunization history, social history, past medication history (e.g. allergies, adverse effects) and patient personal goals of therapy.
The review also aims to identify any issues of non-adherence or difficulties the patient may face in managing their medications. It includes evaluating the timing and grouping of when medications are taken, assessing whether the drugs selected are appropriate, and identifying any concerns of overprescribing or duplicate therapies.
Medication Action Plan
From this review, a tailored Medication Action Plan (MAP) is created. The MAP may contain key points that the patient is advised to discuss with their primary care provider (PCP) or prescribers (e.g. discontinuing a redundant medication), as well as a "To-Do" list for the patient, covering changes in medication timing and diet.
One goal of the pharmacist review and MAP is to minimize medication side effects or adverse events. To do so, the pharmacist provides education around the purpose of medications, side effects to look out for, and more.
Additionally, a Personal Medication Record (PMR) is generated to help the patient keep better track of their medications.
The pharmacist walks the member through their plan and educates them on why the changes are important. Members learn information they can immediately implement, like what to do if they miss a dose of a medication and the optimal time of day to take their medications.
Targeted Intervention Follow-up
The final step of a targeted intervention follow-up (TIP), is essential to monitor response to therapy or refinement of the care plan to achieve clinical goals of therapy. Repeat consults ensure continuity of care and ongoing medication optimization.
The pharmacist works with the member’s health coach to coordinate the implementation of the MAP. The coach is also responsible for sending reminders to the patient, reinforcing the importance of adherence to the medication regimen.
The Impact of Comprehensive Medication Management
For patients with chronic conditions, there is an average 3:1 to 12:1 ROI on offering Comprehensive Management Medication. This return is primarily achieved by reducing medication misuse, overuse, underuse, and the associated consequences. Both members and employers experience great benefits.
Members benefit through a better understanding of their medications and how to take them, which leads to a reduction in adverse side effects and medication-related risk events. Improved adherence also optimizes medication usage, enhancing overall health outcomes.
Pharmacists highlight unnecessary drug therapy and areas where a dosage may be too high. After consulting with their PCP or prescriber, many patients adjust their prescriptions, saving money on high-priced medications.
Additionally, participants in CMM programs are 33% less likely to be rehospitalized within 30 days post-discharge, pointing to a substantial decrease in future medical complications.
Employers see a noticeable increase in member satisfaction relating to their work-life and job contentment, which in turn fosters greater member loyalty to the company. Additionally, the adoption of CMM programs leads to tangible healthcare cost savings for employers. As prescription drug costs rise, employers are focused on reducing spend on prescriptions while ensuring their employees have the medication therapy they need.
CMM not only contributes to the health and well-being of employees but also supports employers in building a loyal, satisfied, and productive workforce while simultaneously achieving cost savings in healthcare expenditures.
Goodpath’s Comprehensive Medication Management
Goodpath members deal with a range of chronic conditions, and are typically on multiple medications. They have access to Goodpath’s Comprehensive Medication Management to learn how to better manage their medications, improve their health and avoid medication-related problems.
At consultation, there is high variability in members’ knowledge about their medications. 89% of members did not have an updated list of all their medications. They had to report their medication list from memory or read it from prescription bottles.
In review, pharmacists determined the most common issues with medication management:
Safety: Adverse drug reaction risk
Indication: Unnecessary or duplicate drug therapy
Safety: Dosage too high
After completing Comprehensive Medication Management, members shared they learned how to properly take a specific medication when a dose was missed.
One member wrote, “Brooke provided me with great recommendations regarding my current medications and possible supplements. She also answered questions and provided me information I didn’t know about my current meds.”
The Goodpath Difference
Medication management is an important part of healthcare, and offering Comprehensive Medication Management has upsides for both employers and employees. CMM ensures medication optimization and improves quality of life. In practice, patients are often overlooked in the retail setting, and therapy management falls by the wayside. Goodpath provides comprehensive medication management for members because proper medication use is critical to overall health.
Medication management is one part of Goodpath’s whole-person care. In addition, Goodpath provides digital exercises, physical products and 1-on-1 health coaching to improve employee health across multiple chronic conditions.
If you’d like to learn more about Goodpath’s Comprehensive Medication Management, request a demo to see how it would work for your team.