5 Tips for Employers on Reforming and Optimizing Medication Use

We are living in an era that promises more personalized healthcare, yet value-based payment models don’t align with the systems of care to support person-centered, team-based care or to focus on safe, effective use of medications and gene therapies to optimize medication use and support high quality outcomes.

Today, 30% of adults in the United States take five or more prescription drugs and they should benefit from - or not be harmed by - the over 10,000 medications available on the market. Medications are common medical interventions; their potential to both help and harm is enormous. More than 275,000 deaths occur annually and over $528 billion - including your benefits dollars - are wasted because drugs are misused, overused, they lead to treatment failure, a new medical problem or both. We can save lives, reduce waste, curtail physician burnout and lower costs by getting the medications right the first time. An evidence-based process for optimizing medication use is comprehensive medication management (CMM).

Why does this matter for you as an employer? The reasons are plentiful, but firstly, achieving medication optimization through comprehensive medication management in practice will reduce waste in health care spending, ensure appropriate use of medications and decrease low-value care. It also supports employers’ fiduciary responsibilities as plan sponsors to manage plan assets and enhances the quality of life and care provided to benefit plan recipients. And, perhaps most simply, it facilitates employees being mentally and physically able to effectively work.

Employers are powerful influencers in driving system change, and they can assert that influence to address misaligned incentives within the medication use system. Here are five things you can do to get involved in medication management reform:

1. Talk to your Vendors. Talk to your vendors and carriers about strategies used in provider networks to track and manage medication therapy problems. Have them outline their quality improvement process for safe, effective, appropriate use of medications. Consider how they link pharmacogenomic (PGx) testing with the process of care to target correct therapies. Determine if their network providers can consistently and positively answer, “Is this the right medication, or combinations of medications, for this person?” Confirm that between your medical carrier and PBM, collaborative and effective processes are being followed and outcomes are measured to ensure appropriate use of medications. Non-adherence is a small part of all medication therapy problems. To be effective, a comprehensive process of care to address problems is essential. 

2. Ask your Vendors for Data and Analytics. Ask your vendors and carriers how they evaluate, measure, track, report and resolve medication therapy problems — wrong dose, wrong drug, adverse events, inadequate therapy, failed therapy, non-adherence. What actions are taken to intervene when providers are consistently identified as being the sources of such problems? Do they reward providers that consistently deliver care absent of medication therapy problems (misuse, over/under use)? Ask for regular reports on how they measure, track and evaluate medication therapy problems (misuse, over/under use).

3. Work with your broker or consultant. If your organization uses brokers or consultants, what are they doing about medication management reform? Ask them to identify current carriers that monitor and evaluate network providers to ensure they have a comprehensive medication use process — not just adherence programs — that rewards providers for safe, effective and appropriate use of medications and gene therapies. Do they offer effective strategies to answer and ensure, “Is this the right medication, or combinations of medication, for your plan members?”

4. Network partners. Partner with primary care and specialist physician organizations and carriers to support and encourage team-based models that have a defined medication use process. Ensure they include and pay for team-based services using a clinical pharmacist as a medication expert, working in collaborative practice with physicians, to get the medications right for the patient populations they serve. What is the process to efficiently answer, “Is this the right medications for my patient?”

5. Integrated Coordinated Care. Engage service providers and consumer groups focused on chronic care management. Encourage them to demand a team-based, comprehensive, patient-centered approach to medication management that includes a medication expert working in collaborative practice with the treating physician to assure the patient receives appropriate, safe and effective medications the first time. Team members should consider all medical conditions of the patient, all prescriptions and non-prescriptions, as well as the patient's mental, physical and financial abilities to use a medication as well as assessing cultural factors that may impact their medication use.

The current system for medication management is broken, and it won't be fixed by just one party. Reform must come from across the board. And taking a look at your own organization, and your solution providers, is the first step.

Katherine Capps, is co-founder & executive director, of GTMRx Institute, a catalyst for change that brings critical stakeholders together, bound by the urgent need to get the medications right.