by Matthew Baki
When employers and consultants discuss ways to improve an employer’s pharmacy benefit, the conversation is always around the cost of medications and rebate dollars. Isn’t it time to change to conversation around pharmacy to be shifted to patient outcomes? Why isn’t the healthcare industry focused on addressing issues caused by non-optimized medication use—ensuring each medication is safe, effective, and appropriate? After all, $528 billion dollars are wasted each year due to non-optimized medication use and over 275,000 people die each year from this problem. 1,2,3
Your Healthcare Waste Solution: Comprehensive Medication Management
Here's the good news, the solution to address is problem already exists; it’s called Comprehensive Medication Management (CMM). As medication experts, pharmacists can identify drug therapy problems and make recommendations to the treating physician(s) to resolve such issues.
Led by clinical pharmacists, patients receive a comprehensive medication review, including:
- Alternative medications
- Review all medical conditions
This ensures each medication is safe and appropriate for the patient, has been prescribed at the right dose, is taken at the right time, and is achieving the right outcome. As medication experts, pharmacists can identify drug therapy problems and make recommendations to the treating physician(s) to resolve such issues.
As a benefit solution provider, Tria Health has been providing CMM to self-funded employers since 2009. Non-optimized drug use is problem for people of all ages, not just seniors on Medicare. Tria Health’s average patient:
- is 51 years old
- takes 9 medications
- manages 6 medical conditions (3 of which are chronic conditions)
- is treated by 3 different physicians
I know, that’s a lot to manage.
Isn’t the patient’s doctor managing this? Or shouldn’t the Pharmacy Benefit Manager (PBM) be catching these issues?
Unfortunately, physicians only have time for an average office visit time of 15.9 minutes. During that time, they spend 26 seconds on guideline-recommended components and 23 seconds on all other aspects of a prescription when talking to patients about a new medication. 4 As for the PBM’s, their clinical services are episodic in nature, vs a proactive approach CMM provides. They are also typically limited to drug-to-drug interactions, utilization management and focused around increasing formulary compliance or adherence. While these programs are important to have in place, they do not accomplish the same goal of CMM—ensuring safe, appropriate, and effective medication use.
As Tria Health’s clients have experienced, CMM is the most effective solution. Not only are their employees and family members living healthier and happier lives, but they receive on average a 3.6:1 ROI. As validated by the Validation Institute in a matched cohort study, from 2017 -2019, engaged patients with Tria Health experienced a 41% decline in ED costs and a 59% reduction in Inpatient cost.
Yes, the cost of medications needs to be addressed at a national level. But the price point of a medication that doesn’t produce the intended result is exponentially higher, and it’s seen in both pharmacy and medical claims. Isn’t it time for employers to start thinking about how pharmacy utilization at the patient level impacts overall healthcare spend?
- Cutler DM, Everett W. Thinking outside the pillbox: medication adherence as a priority for health care reform. N Engl J Med. 2010;362(17):1553-1555PubMedGoogle ScholarCrossref
- Watanabe J, et al. Cost of Prescription Drug–Related Morbidity and Mortality. Annals of Pharmacotherapy, March 26, 2018. Accessed 3 April 2018.
- Watanabe JH, McInnis T, Hirsch JD. Cost of Prescription Drug–Related Morbidity and Mortality. Annals of Pharmacotherapy. 2018;52(9):829-837. doi:10.1177/1060028018765159
4.Tarn, D. M., Paterniti, D. A., Kravitz, R. L., Heritage, J., Liu, H., Kim, S., & Wenger, N. S. (2008). How much time does it take to prescribe a new medication? Patient Education
and Counseling, 72(2), 311-319. https://www.sciencedirect.com/science/article/pii/S073839910800116X?via%3Dihub