As the Director of Clinical Services at Mosaic Pharmacy Service, Sapna Patel, RPh, is responsible for overseeing the development and delivery of clinical services for all Mosaic members. This month we asked Ms. Patel to share insights on the most common challenges and scenarios her team experiences when working with members and how Mosaic’s high-value pharmacy service helps to support better health outcomes moving forward.

1. “What are the most common barriers to adherence or proper medication use you’ve seen in your members, and how does Mosaic help address these challenges?”

The three most common barriers to medication adherence we see are:

1- Cost

The inability to pay for medications is a major adherence barrier for our members. The cost of drugs has led to many of our MAPD members stopping treatment once they hit the gap phase of their insurance. In fact, many people are experiencing regular price increases 1-2 times per year.1

Mosaic addresses cost barriers by working to understand each member’s unique situation and how we can help. The Mosaic team is unique in that we use software called Therapeutic Decision Support that alerts us when members may be approaching the coverage gap or may benefit from a lower cost therapeutic alternative based on the health plan’s formulary. In scenarios like that, we work with both the member and prescriber to identify a more affordable alternative in order to keep the member adherent to that regimen.

2- Unnecessary Polypharmacy

The consequences of unnecessary polypharmacy, particularly among older adults, is a big reason why Mosaic began its work. For these members, managing multiple medications can be a challenge when they have cognitive impairment, transportation issues, functional limitations, and financial restraints.

Mosaic addresses the risks associated with polypharmacy by conducting a clinical review on each member’s medications before the first month’s medication shipment goes out. In about half of all members, we find opportunities to reduce unnecessary polypharmacy. We raise these recommendations to the member’s prescribers and work to have the regimen changed with their approval. Once approved, we’ll place all medications into easy-to-use adherence packaging and deliver it to the member’s home.

3- Pharmacy Health Literacy

Pharmacy health literacy2 is another area of concern. Members who do not understand his/her disease states and corresponding drug therapies, will not stay adherent to their medications.

Studies show that improving health literacy could prevent nearly one million hospital visits and save over $25 billion a year.3  We improve health literacy at Mosaic by discussing each medication with the member so they know the reason they are taking it and can ask questions about effectiveness, side effects, and costs. Our pharmacists also talk to members about managing their chronic diseases, and follow up regularly about their medication use, interaction with their prescribers, and overall health.

2. “What’s your most surprising finding from your virtual home visits?”

The most surprising finding when on-boarding new members is the prevalence of unused and expired medications in their homes, which is typically the result of non-adherence or frequent medication changes.

Members are often unsure of how to safely dispose of unused or expired medications, which results in stockpiling.  Stockpiling can cause confusion, wasted medications, and unsafe or improper medication use. To address this, Mosaic provides take-away bags with the member’s first medication shipment. Members can use these bags to mail out unnecessary medications for proper disposal. Providing this extra level of service reduces the chance of improper or unsafe medication use, which can lead to serious harm.

3. “How is Mosaic different than other pharmacy services available?”

Mosaic combines technology with a comprehensive clinical care model to create outcomes unlike other pharmacies. Therapeutic Decision Support™ (TDS), powered by RxAnte’s analytics, helps Mosaic pharmacists optimize our members’ medication regimens. Supported by this technology, we can better coordinate with prescribers to add, remove, or change medications to maximize therapeutic effect, while ensuring the patient is paying the lowest possible copays for their medications.

TDS also allows our team to see a member’s progression to the gap phase of his/her insurance. If a member is about to reach the gap phase, our technicians will discuss this with them on their monthly check-in call. If the member is unable to afford a medication, a Mosaic pharmacist will contact the provider to recommend a less expensive, but equally effective alternative.

Lastly, TDS alerts the pharmacist on any potential CMS Stars polypharmacy or SUPD concerns. The clinical pharmacist works with the patient and provider to resolve these concerns as quickly as possible.

Ultimately, Mosaic pharmacists supported by TDS have been able to improve medication use among our members by directly addressing cost, complexity, and safety concerns—resulting in safer, simpler, and more affordable regimens.