Many of us have someone in our life—a parent, a spouse, or loved one—who has one or more chronic conditions. If one of those conditions is type 2 diabetes, that person may be taking seven prescription medications,1 managing two or more additional chronic conditions,2 and paying $13,000 per year on healthcare.3 They are also 2.6 times more likely to be hospitalized versus people without diabetes. Unless you are this person’s caretaker, you may not realize just how complex their condition is.
Each prescription medication a patient takes is a responsibility, and when an individual is taking five or more medications, those responsibilities become a complicated puzzle of elements to manage, such as proper dosage, compliance and adherence, potential drug interactions, and the correct time and method for use. When you add in demographics such as the patient’s financial status, trust in prescribers, motivation to prioritize personal health, emotional and mental well-being, and health literacy, the puzzle becomes even harder to solve. In the U.S., 40% of people have multiple chronic conditions4 and that number is growing by 1% each year.5 This links to 22% of U.S. adults aged 40-796 and 42% of U.S. senior adults (aged 65+)7 taking five or more prescription medications.
Polypharmacy, which refers to the use of five or more medications to treat chronic conditions, has several elements that need to be addressed and solved for. Most importantly, there are two types of polypharmacy. First, a patient may be on the incorrect regimen, in which they are prescribed more medications than are necessary or medications that negatively interact. These situations must be urgently identified and adjusted to a proper treatment plan. Second, a patient may be on the right regimen, in which their five or more drugs are prescribed based on clinical evidence. In this scenario, it’s important to prioritize patient education, access, and continued adherence. Both types of polypharmacy patients have an increased risk for adverse effects, with polypharmacy accounting for 30% of all hospital admissions.8
Adherence Drops Off as Patients Take More Medications
Adults taking just one prescription are likely able to conveniently manage their medication regimen. Adults taking five or more prescription drugs, however, may use multiple pharmacies or have 30-day refill cycles that don’t line up—requiring multiple visits to the pharmacy each month. Not only does this consume valuable time and effort, but it also increases the likelihood of medication errors and mismanagement. When it comes to starting, adhering to, and properly taking medication, some key statistics to know are:
- 30% of prescriptions for chronic conditions are never filled9
- 50% of patients stop taking their medications within the first year9
- 50% of prescriptions are not taken as directed10
For optimal efficacy of medications, adherence rates of 80% or higher are typically needed. To no surprise, nonadherence is more prevalent as people take more medications. Eighty percent of studies on the relationship between polypharmacy and nonadherence report that patients taking five or more medications have a greater risk of nonadherence.11 Forgetfulness, cost, and convenience factors such as distance or transportation to pharmacy are the main drivers of this nonadherence.
To help solve for these problems, it’s common for the Centers for Medicare and Medicaid to conduct adherence programs through pharmacies. Pharmacies are incentivized by Medicare Star ratings and smaller direct and indirect remuneration (DIR) fees to prioritize these programs, which typically focus on three main disease states: diabetes, high blood pressure, and cholesterol. However, these adherence programs are not a catchall solution, leaving gaps for patients under 65, on commercial insurance, and with other conditions.
Look to the Medication Experts to Help with Polypharmacy
Reaching prescribers such as physicians is crucial to getting patients on therapy; however, physicians may not have the full view of a patient’s regimen. Older adults with five or more chronic conditions see 14 different physicians,12 and the average American patient sees an average of 18.7 different doctors during their lives.13 While primary care physicians can sometimes piece together a patient’s full treatment regimen, studies have found that patients often fail in reporting medications prescribed by other practitioners.14 Plus, 30% of people with chronic conditions do not see a primary care physician at all.15
Pharmacists are true experts in the clinical use of medications and see patients with chronic conditions up to 10 times more per year than their physicians do.15 Pharmacists often have a bird’s-eye view of all medications a patient is taking which allows them to conduct medication therapy management (MTM). MTM can include conducting medication reviews, ensuring patient adherence, addressing gaps in therapy, referring patients to other care providers, and more. MTM is essential for polypharmacy patients with an inadequate regimen, as pharmacists can identify negatively interacting medications, improper dosage, drug-disease interactions, and medications that are no longer needed. Pharmacists have some prescribing authority and ability to modify drug regimens, but in cases where they do not, they may contact the prescriber directly for recommended therapy changes.
Empower, Educate, Nudge, and Remind Patients
For polypharmacy patients on the right regimen, pharmacists can empower patients to better control their health by educating on conditions and treatments, addressing social determinants of health, and creating a more efficient refill schedule. Pharmacies can help patients switch to 90-day fills instead of 30-day fills, a change that leads to a 19% increase in adherence.16 Pharmacies can also conduct order grouping, in which all medications are synced to the same refill date, making patients 2.6 times more likely to be adherent and 21% less likely to discontinue therapy.17
These changes can address convenience barriers, and sometimes help with financial barriers as well. Regarding forgetfulness, pharmacies can combat this with texting and call programs that regularly provide nudges and reminders. Nudging patients at key moments in their treatment journey—such as when they have a new prescription, the prescription is ready for pickup, the prescription is ready for refill, or the patient is late to fill—is shown to improve first fill pickup rate, bring patients back to therapy, and increase adherence.18
While patients are picking up scripts, pharmacists may encourage patients to receive care including vaccinations, eye exams, and flu and strep testing. For Medicare patients, pharmacists may proactively help with plan comparisons and choosing the best option. Younger generations also view pharmacies as site of care, with 56% of Gen Z and 54% of Millennials receiving healthcare services at a local pharmacy in the last year.19
For medications that require monitoring and assessing, pharmacists can conduct screenings—such as blood pressure, cholesterol, and A1C—to regularly assess drug efficacy. These additional services are key to helping the polypharmacy problem because better self-reported health correlates directly with improved medication adherence.20
Manufacturers Should Create Strong Pharmacy Relationships
Pharma brands understand their patient population well enough to know the co-morbidities and total number of medications for their average patient. If that population includes polypharmacy patients, brands should consider all the challenges and barriers facing these individuals and focus on empowering them to stay adherent. One clear path for helping this group is through the pharmacy.
Much like payers working with pharmacies to conduct comprehensive medication reviews (CMRs) and other interventions, manufacturers can take a similar approach. Pharmacies often welcome any programs, including those sponsored by manufacturers, that will boost adherence metrics among a wide range of patients and for other high-importance categories including mental health, asthma, and COPD, to name a few.
Examples of programs that manufacturers can sponsor include pharmacist-led consultations and texting. Pharmacist-led consultations refer to patient interventions, such as MTM, where pharmacists can have live one-on-one conversations with a patient on a specific topic, such as adhering to a medication. Texting programs leverage the messages that patients already receive from their pharmacy—such as refill reminders—and can reach patients on specific treatments to provide additional resources such as a how-to video or a coupon. By adding their expertise and patient-facing resources to pharmacy programs, manufacturers can reach polypharmacy patients at precise moments in their journey and help them stay on track.
Pharma companies can dedicate team members to building and creating pharmacy relationships, or they can partner with a vendor that has an existing network of pharmacies to leverage. Keep in mind that to properly reach a targeted population, the pharmacy network should include national chains, regional chains, and retail independents across rural, urban, and suburban areas. Depending on the demographic, the pharmacy network may also need adequate access to commercial, cash-paying, Medicare, or Medicaid patients.
Manufacturer programs through a pharmacy network can help polypharmacy patients when focused on specific objectives such as identifying adherence barriers, getting patients on 90-day fills or grouped refills, and educating the patient. For example, data from Outcomes demonstrates that manufacturer-sponsored pharmacy texting programs lead to:
- 82% first fill pickup rate
- 27% of nonadherent patients returned to therapy
- 23% adherence lift
- 0.74 additional fills per patient per year
- 30% increase in multi-dose vaccine completion18
Another tool that manufacturers should use is direct education to the pharmacists. Research shows that pharma manufacturers spend 55% of their marketing budgets on reaching HCPs.21 But brands should allocate resources to educating more than just the prescribers. Pharmacists, too, must be kept up to date on products, including new indications, data around efficacy, and talking points for patient conversations.
Navigating healthcare is hard. All the factors of a polypharmacy patient’s health create a puzzle. Fitting all these pieces perfectly together isn’t easy, but elevating pharmacy contributes to making the biggest impact.
References:
1. National Center for Biotechnology Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8413418.
2. National Center for Biotechnology Information: https://www.ncbi.nlm.nih.gov/books/NBK567979.
3. National Association of Chronic Disease Directors: https://www.chronicdisease.org/resource/resmgr/white_papers/cd_white_paper_hoffman.pdf.
4. Centers for Disease Control and Prevention: https://www.cdc.gov/chronicdisease/about/index.htm.
5. Partnership for Solutions (A Project of Johns Hopkins University and The Robert Wood Johnson Foundation): http://www.partnershipforsolutions.org/DMS/files/chronicbook2004.pdf.
6. Centers for Disease Control and Prevention: https://www.cdc.gov/nchs/products/databriefs/db347.htm.
7. Lown Institute: https://lowninstitute.org/projects/medication-overload-how-the-drive-to-prescribe-is-harming-older-americans.
8. U.S. Pharmacist: https://www.uspharmacist.com/article/polypharmacy.
9. Healthcare Finance News: https://www.healthcarefinancenews.com/news/pharmaceutical-companies-should-focus-medication-adherence-improve-revenue.
10. Centers for Disease Control and Prevention: https://www.cdc.gov/mmwr/volumes/66/wr/mm6645a2.htm.
11. National Center for Biotechnology Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335752.
12. National Center for Biotechnology Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924996.
13. Fierce Healthcare: https://bit.ly/43YPWMg.
14. National Center for Biotechnology Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4041129.
15. National Center for Biotechnology Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755826.
16. Express Scripts: https://bit.ly/3p5jh8Y.
17. National Community Pharmacists Association: https://ncpa.co/uploads/Arkansas-Report-Final.pdf.
18. Outcomes data.
19. Beckers Hospital Review: https://bit.ly/3X89YRW.
20. National Center for Biotechnology Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5704980.
21. MM+M: https://bit.ly/45ZPBdY.
