Polypharmacy and the Pivotal Role of the Payer

Our healthcare system is very good at starting medications.

And very bad at stopping them.

Karen Schulte

According to the Centers for Disease Control and Prevention, about 1 in every 5 adults takes five or more prescription drugs. The rate is twice that among older adults.

By itself, this trend is not cause for concern. However, polypharmacy — defined as taking five or more medications simultaneously — poses dangers, such as memory decline, falls and hospitalizations. One study has predicted that up to 150,000 premature deaths due to adverse drug events from polypharmacy. Moreover, unnecessary medications put a financial strain on patients and the healthcare system overall.

To fix this problem, experts advocate for routine medication reviews by physicians and pharmacists. However, fragmented care and overwhelming workloads often hinder such reconciliations.

Enter the payer

While various stakeholders in the healthcare system have a part to play in deprescribing, too often the one that goes overlooked is the clinician on the payer side. Payers have nearly instant access to pharmacy records and, by collaborating closely with healthcare providers, can play an outsized role in curbing the overuse of medications and improving patient outcomes.

Sharon K. Jhawar, Pharm.D., MBA

In 2021, SCAN Health Plan, the Medicare Advantage plan whose pharmacy team we lead, reviewed our members’ medication schedules. From that single review, we determined that 51% of our nearly 300,000 members were experiencing polypharmacy and that 12% were experiencing hyper-polypharmacy (more than 10 medications).

Were all of these medications necessary? To find out, we contacted the physicians of about 18,000 members who took 15 or more drugs regularly and simply asked them to review their patients’ regimens. Within months, 92% of these members had discontinued the use of at least one drug.

Encouraged by the results, in 2022, instead of just looking at members experiencing hyper-polypharmacy, we focused on specific therapies that were commonly prescribed and likely to be refilled indefinitely. These drugs included fall-inducing medications (sleep aids/hypnotics), stomach acid-reducers (proton pump inhibitors), duplicative diabetes treatments and high-risk diabetes drugs (long-acting sulfonylureas). We then made a total of about 16,000 deprescribing recommendations. Almost 2,500 were implemented.

We increased our efforts last year, sending 38,000 deprescribing recommendations to the providers for 33,000 patients. Twenty-five percent of those recommendations were implemented and 8,800 patients were taken off unnecessary medications.

Positive impact and cost savings

In addition to positively affecting health outcomes, deprescribing can lower costs. The Lown Institute estimates that it will cost $62 billion over the next decade to provide medical care to people who suffer adverse drug events related to overprescribing.

We estimate that our deprescribing efforts saved our members $126,000 in annual out-of-pocket costs last year. And by reducing the risk of fractures, falls, emergency room visits due to low blood sugar and other adverse drug events, we estimate the annual savings from our deprescribing effects to the healthcare system added up to approximately $2 million per year. 

Opportunities ahead

There are several ways payers can monitor polypharmacy. One of the simplest and most reliable is via claims data review.

At SCAN, we’ve taken this process further and now perform regular reviews of claims data to pinpoint specific drugs with limited long-term benefits that are being taken indefinitely. After that, it’s a simple matter of contacting the prescriber — either directly through electronic health record or via fax — in order to have the prescription reviewed. We are currently determining if there is an additional benefit in contacting the patient as well. Our belief is they too have a role to play in ensuring they only take medications that are medically necessary.

Based on this experience and concerned about the rate of polypharmacy, the path forward for all health systems is clear: We must forge stronger collaborations between payers and healthcare providers in order to reduce the prevalence of unnecessary medications. It’s time for the healthcare system to rise to the challenge and integrate evidence-based deprescribing into standard care practices. By doing so, we can empower older adults to live the vibrant, healthy and independent lives that they deserve.

Karen Schulte is president of the Medicare division of SCAN Health Plan, not-for-profit headquartered in Long Beach, California.

Sharon K. Jhawar, Pharm.D., MBA, is chief pharmacy officer of SCAN Health Plan.