A claims professional noted that a patient’s drug regimen included 11 medications, raising serious concerns. However, each individual drug seemed to be prescribed with a legitimate medical need.
How does a claims professional determine when the number of medications in a patient profile is too many?
WHAT IS POLYPHARMACY?
Polypharmacy is the simultaneous use of multiple medications in an individual patient. While there are instances in which polypharmacy is necessary and appropriate, polypharmacy is often inappropriate and can lead to patient safety concerns and higher costs.
WHAT ARE THE SAFETY CONCERNS OF POLYPHARMACY?
Polypharmacy can cause adverse effects that worsen a patient’s health, putting them at risk of serious harm and even death.1-2 Downstream effects from adverse events can also result in delayed functional improvement and return-to-work.
WHAT ARE THE COST CONCERNS OF POLYPHARMACY?
In addition to increased pharmacy costs resulting from a high number of medications, polypharmacy can trigger adverse drug events that contribute to overall medical costs. For instance, opioid-induced constipation can double total healthcare costs during the first year of opioid therapy.3
WHEN DOES POLYPHARMACY BECOME PROBLEMATIC?
Polypharmacy becomes a concern when it contributes to:
- New adverse effects
- Drug/drug interactions
- Drug/disease interactions
- Incorrect dosing
- Duplication of therapy
- Inappropriate drug use
- Lack of benefit for the patient
- Lack of functional improvement
WHAT CAN CLAIMS PROFESSIONALS DO ABOUT POLYPHARMACY?
Clinical intervention is incredibly beneficial as it can lead to simpler drug regimens, increased patient safety, improved patient outcomes, and reduced costs.
Intervention opportunities include:
- Coordinating communication and patient care between prescribers and the patient
- Ensuring the patient understands his/her drug regimen and is adherent to it
- Requesting comprehensive drug regimen reviews
- Educating the patient about the importance of using a single pharmacy or pharmacy network
- Instructing the patient to request prescriptions from their physicians instead of accepting medications from them directly
- Requesting documentation of a patient’s progress and treatment plan from the physician(s)
- Discussing alternative, non-drug therapies