September 04, 2015
Medications are a mainstay in the US health care system. According to CDC statistics, three out of four doctor visits involve a medication in some way.
So it’s not too surprising that nearly half of Americans have used at least one prescription medication in the past month. Among Americans ages 60 and older, more than a third are taking five or more drugs. This is called polypharmacy, which by one common definition means using five to 10 prescription drugs.
Health experts are turning more attention to polypharmacy, which can be particularly risky for seniors. A variety of health care stakeholders, including pharmacy benefit managers, are researching the consequences of polypharmacy and preventive strategies to reduce it.
About 25 percent of the US population has multiple chronic conditions, such as heart disease, cancer, diabetes, arthritis and mental issues like depression, according to federal statistics. The risk rises with age; roughly three out of four seniors ages 65 and older may have multiple chronic diseases.
Often, seniors who are using a high number of medications to treat these conditions may meet another definition of polypharmacy, which is “the use of more medications than are medically necessary.” Perhaps they’re taking medications that aren’t indicated or aren’t likely to work.
The consequences of polypharmacy, however, extend well beyond merely taking ineffective medications. Negative outcomes linked to multiple prescription use include:
A comprehensive approach involving patients, physicians and pharmacists can reduce polypharmacy and its associated risks.
Express Scripts, a pharmacy benefit manager (PBM), recommends that physicians perform medication reviews with their patients who are taking multiple prescriptions. Important questions to ask include: Are these all necessary? Could any have harmful interactions? Are any available in generic form?
“Doing so can eliminate inappropriate or duplicative medications and often result in better health outcomes and lower costs,” the company notes, adding that pharmacists – including those within PBMs – can also perform these reviews.
According to OptumRX, other ways that PBMs and health plans can address polypharmacy include:
Seniors with several chronic conditions often receive treatment from multiple physicians. Because independent review organization (IRO) experts can examine a patient’s entire file, containing multiple medical records, our unique vantage point lets us see all the medications a patient is taking.
Our physician reviewers at AMR evaluate why patients are taking each of their medications. Often, providers respond that “I inherited the patient that way, and they have been taking that medication for years.”
Many of our reviews involve a peer-to-peer call between one of our physician reviewers and the patient’s prescribing physician to address medications. Often we can recommend changes to the patient’s medication regimen that will improve outcomes.
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