SAN DIEGO – Prescription medications are a major contributor to unnecessary health care spending.
According to data from the Centers for Medicare & Medicaid Services, retail spending on prescription drugs grew 12.2% to $297.7 billion in 2014, compared with the 2.4% growth in 2013. That’s one key reason why medication reconciliation should be performed at every inpatient and outpatient visit and prior to every hospital discharge, Dr. Aparna Kamath said in a video interview at the annual meeting of the Society of Hospital Medicine. “The focus should be on clear indications for each medication prescribed, substitution of generics when possible, and consideration of an individual patient’s insurance formulary and ability to meet out-of-pocket costs.”
A recent article in JAMA Internal Medicine discussed the practice of “deprescribing” in an effort to reduce the number of prescribed drugs (2015;175:827-34). According to Dr. Kamath of the department of medicine at Duke University Health System, Durham, N.C., who was not involved with the article, deprescribing “means safely narrowing, discontinuing, or withdrawing medications for our patients. It has been shown that deprescribing might actually improve outpatient outcomes by making the medication list safer for our patients and hopefully also improve medication adherence by making them more affordable for our patients.”
The study authors proposed a five-step protocol for deprescribing:
• Ascertain all drugs the patient is currently taking and the reasons for each one.
• Consider overall risk of drug-induced harm in individual patients in determining the required intensity of deprescribing intervention.
• Assess each drug in regard to its current or future benefit potential, compared with current or future harm or burden potential.
• Prioritize drugs for discontinuation that have the lowest benefit-harm ratio and lowest likelihood of adverse withdrawal reactions or disease rebound syndromes.
• Implement a discontinuation regimen and monitor patients closely for improvement in outcomes or onset of adverse effects.
According to Dr. Kamath, other medication reconciliation strategies include referring patients to a social worker to inquire about drug assistance programs; following up with the patient’s primary care or prescribing physician; partnering with pharmacists; and educating patients about variance in prescription drug prices. “I think it’s important to inform the patients that these drugs are priced differently in different pharmacies,” she said. “According to Consumer Reports, we should ask the patient to shop around, maybe call the medication pharmacies in their local area to find out where they can find the drugs at a most affordable price. We can also advise our patients to ask for discounts or coupons, and check for monthly price changes,” Dr. Kamath said. She recommended the following websites, which allow patients to compare costs and/or inquire about discounts:
Dr. Kamath reported having no financial disclosures.