Approximately one in five drugs commonly prescribed to those 65 years and older may be inappropriate1, increasing to one in three among those living in aged care facilities2. Adverse drug events for those on inappropriate medication regimens, especially those members who are polypharmacy (on five or more medications), include ill health3, disability4, hospitalization5, and, in some cases, death6. In fact, the number of medications a patient is taking is the most important predictor of potential prescribing problems from medications.7
As agents of positive change in healthcare, we believe these disturbing statistics can be combated with the process of deprescribing. With this approach, drugs are identified and discontinued in instances in which existing or potential harms outweigh existing or potential benefits. Deprescribing occurs within the context of an individual patient’s care goals, current level of functioning, life expectancy, values, and preferences.
Deprescribing is part of the Pharmacist’s Patient Care Process, which includes therapy initiation, dose titration, changing or adding drugs, and switching or ceasing drug therapies.
Finding the Hard Savings in Deprescribing
Using clinical guidelines and 2016-17 claims data for a health plan client, we set out to identify the maximum potential first-year savings from deprescribing certain therapy areas believed to be overprescribed. We looked at the four therapy areas most commonly overprescribed in senior care out, out of a known set of problematic drugs: proton pump inhibitors (PPI); antipsychotics; benzodiazepines (BZDs); and cholinesterase inhibitors.*
Here’s what we found:
- Plan savings around $2 million or more for each line of business were identified among members using PPIs.
- Specifically, between 50% and 75% of all current costs on PPI could potentially be saved through deprescribing.
- Members on antipsychotics would also yield large savings within the Medicaid population.
Health Plans Get More From Deprescribing Than Just Cost-Savings
The main benefit to plans would be the immediate cost savings that result from deprescribing. However, there are a number of ancillary benefits as well: prescription cost savings, reduced medication burden for members, enhanced adherence to other medications that members may be prescribed, and more.
Adding deprescribing to high-touch pharmacy outreach programs or enhanced medication therapy management and/or clinical programs could lead to immediate cost-savings. The healthcare industry is just beginning to understand the real implications of deprescribing, but it’s clear that health plans that want to reduce costs and improve care should take advantage of the value deprescribing already provides.
RxAnte already helps health plans improve adherence with pharmacy outreach programs, our RxEffect intervention management platform, and deprescribing. Learn more.
*This analysis is a first-pass and refinement of clinical details and outreach program design are required.
1 Roughead EE, Anderson B, Gilbert AL. Potentially inappropriate prescribing among Australian veterans and war widows/widowers. Intern Med J. 2007;37(6):402-5.
2 Stafford AC, Alswayan MS, Tenni PC. Inappopriate prescribing in older residents of Australian care homes. J Clin Pharm Ther. 2011;36(1):33-44.
3 Anathhanam S, Powis RA, Cracknell AL, Robson J. Impact of prescribed medications on patient safety in older people. Ther Adv Drug Saf. 2012;3 (4):165-174.
4 Opondo D, Eslami S, Visscher S et al. Inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review. PLoS One. 2012;7(8):e43617.
5 Kalisch LM, Caughey GE, Barratt JD, et al. Prevalence of preventable medication-related hospitalizations in Australia: an opportunity to reduce harm. Int J Qual Health Care. 2012;24(3): 239-249
6 Jyrkkä J, Enlund H, Korhonen MJ, Sulkava R, Hartikainen S. Polypharmacy status as an indicator of mortality in an elderly population. Drugs Aging. 2009;26(12):1039-48.
7 Steinman MA, Miao Y, Boscardin WJ, Komaiko KD, Schwartz JB. Prescribing quality in older veterans: a multifocal approach. J Gen Intern Med. 2014;29(10):1379-1386.