Lowering high-risk medicine mishaps

While representing just 13 percent of the U.S. population, people over 65 account for one third of the nation’s annual spending on outpatient prescription drugs.2 With higher drug utilization also comes greater risk of these members receiving one or more high-risk medicines (HRMs) and suffering an adverse drug effect. And, one in six hospital admissions for older adults is because of an adverse drug event, a rate four times higher than that of younger people.3

What are HRMs?

The 53 medicines considered “high risk” may be routine for younger members. But they are inappropriate for older patients because they are either ineffective or increase the risk of an adverse event. Identified by using one of several industry standards (the most common one called the Beers’ Criteria), these drugs fall into three general categories:

  • Should always be avoided
  • Potentially inappropriate1
  • Should be used with caution

A doctor not familiar with the entire list, or unaware of other drugs a member is taking, may mistakenly prescribe one of these drugs for an elderly member.

A better way

Recently, Prime Therapeutics (Prime) worked with one of our Blue Cross and Blue Shield (Blue) Plan clients to create and pilot an innovative approach aimed at reducing the number of prescriptions for HRMs among its Medicare members.

We created a pilot program with three goals:

  • Reduce the number of prescriptions for HRMs for older adults
  • Reduce costly adverse effects from HRMs among older adults
  • Help the plan earn a 5-Star rating from Centers for Medicare & Medicaid Services (CMS) (Introduced in 2008, the rating system measures collaboration efforts between health plans and pharmacies)

Real-time messaging pays off

The pilot sent real-time message alerts in the electronic prior authorization (ePA) portal to doctors at the time they began the process of prescribing a high risk medicine.

  • The pilot program ran from January to June 2015.
  • It evaluated the effect of real-time messaging alerts sent in through the ePA portal.
  • The messages were delivered for nearly 850 prescriptions among nearly 450 of the plan’s Medicare members.
  • The messages alerted prescribers to the safety concerns associated with specific HRMs.
  • Messages suggested alternative therapies to be considered in each case.

Being proactive paid off. The results of this pilot program showed a nearly 50 percent reduction in HRM prescriptions and a major reduction in the number of Medicare members who received a prescription for an HRM.4

As a result of this success, Prime will now offer the product to all Medicare clients. We’ll also keep exploring innovative ways to communicate with doctors through electronic messaging. 

Next story: Drug exclusion cuts $1 million from employer spend in six months

1 Rochon, M.D., Paula A. “Drug Prescribing for Older Adults.” UpToDate. Schmader, M.D., Kenneth. August 5, 2015. Wolters Kluwer. Retrieved August 2015 www.uptodate.com/contents/drug- prescribingfor-older-adults

2 Pretorius, M.D., MPH, Richard; Gataric, M.D., Godana; Sedlund, M.D., Steven K.; Miller, RPh, John R. “Reducing the Risk of Adverse Drug Events in Older Adults.” American Family Physicians. March 1, 2013. Retrieved August 2015 www.aafp.org/afp/2013/0301/p331.html

3 Knapp, BSPharm, Cynthia. “Medicare star ratings: Stakeholder proceedings on community pharmacy and managed care partnerships in quality.” Journal of American Pharmacists Association. February 19, 2014. Published online April 25, 2014.

4 Prime internal analysis, 3Q2015.

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