Discovery

Member Background

A 71-year-old female was referred to Mosaic by her health plan. This member had a medical history including hypertension, overactive active bladder, brain tumor, glaucoma, high cholesterol, asthma, and cellulitis. On her virtual visit, she reported having muscle aches, swelling, falls, and dry mouth. She also reported being hospitalized due to overdosing on her medications. The member was on 18 medications.

Therapy Problems

During the medication review, a Mosaic pharmacist identified the following issues with the member’s drug regimen:

  • Dosage: the member had two falls as a result of a high dosage of gabapentin
  • Side effects: unwanted side effects included dry mouth and daytime drowsiness:
  • Cost: the member’s Gabapentin copay was $48; Divalproex ER was $44
  • Drug-drug interactions: Warfarin, diclofenac gel, and ibuprofen resulted in increased risk of bleed
  • Adherence: the member was forgetting whether she had taken her medications

Interventions

Provider communication and recommendations for decreasing dose and cost of the members medication. Therapeutic Decision SupportTM (TDS) was used to identify cost savings and eliminating side effects.

  • Consulted with the member’s primary care physician to recommend a decreased dose of gabapentin, change in the dose of divalproex sod, discontinue ibuprofen 600mg, and do a bone density test
  • Educated member on signs and symptoms of bleeding
  • Used TDS to identify tier alternatives for cost savings; the member was on three Tier 4 medication, ultimately switching 1 medication to Tier 1 and discontinuing another medication
  • Advised member to start OTC Xylimelts to help with dry mouth
  • Started member Mosaic packaging to improve safety and adherence

Outcomes

Mosaic improved adherence by simplifying the member’s medication regimen and decreasing her costs and medication side effects.

  • No additional falls since the dose of gabapentin was decreased
  • Ibuprofen discontinued
  • Reduced side effects of dry mouth and daytime drowsiness
  • Member now adherent to all medications and is not worried about overdosing
  • Member cost savings: $1104/yr;  health plan cost savings: $2,676/yr

 

“I haven’t fallen and I feel so much better since you helped change my medications, thank you for all you did for me!”

-Mosaic member