1. Drug interaction and adherence problem driven by time of day
During a recent Comprehensive Medication Review (CMR) with a 75-year-old man, a pharmacist noted that the member was not adherent to his simvastatin. The member admitted that, more often than not, he forgets to take his simvastatin because it is supposed to be taken in the evening, and he takes all his other medicines in the morning.
The pharmacist also noticed that one of his other meds, amlodipine, can interact with simvastatin, increasing his risk for rhabdomyolosis (a condition that causes muscles to break down, resulting in muscle pain and burning).
With the member’s permission, the pharmacist contacted his doctor to suggest a change to atorvastatin. This statin can be taken in the morning and would not interact with his other medicines. His doctor approved this suggestion and atorvastatin was prescribed.
In addition, the member said that he was not using his Advair inhaler for his COPD due to cost. The doctor approved the pharmacist’s recommendation to switch to nebulizer solution(s). These are available as generics and are much less expensive than brand-name drug Advair.
Both of these suggestions helped the member improve his adherence and his quality of life.
2. Pharmacist intervention freed member from being homebound by symptoms
An MTM pharmacist recently spoke with a member experiencing shortness of breath. She denied chest pain, but reported that she couldn’t even leave her house due to her shortness of breath. The member had no history of asthma or COPD. Her doctors were uncertain what was causing the shortness of breath.
During the CMR, the pharmacist discovered that for several years the member was taking nitrofurantoin for prevention of chronic urinary tract infections. Nitrofurantoin is considered a high-risk medicine. It is not recommended for use in those over the age of 65 due to the risk for pulmonary toxicity. This could account for the increased shortness of breath.
The pharmacist contacted the member’s doctor, who discontinued the nitrofurantoin and changed her to an alternative medication. When contacted for a follow up, the member was feeling much better, and thanked the pharmacist for helping her improve her quality of life.
3. Pharmacist discovers unintentional doubling of medicine
During a recent CMR, a member reported that her blood pressure had been low, and she had fallen several times. The pharmacist noticed that the member was taking both irbesartan and valsartan. These are in the same drug class of blood pressure medications, and rarely used together. The member’s doctor had changed her from irbesartan to valsartan, but the member hadn’t been informed to stop the irbesartan. The member was enrolled in her pharmacy’s auto-fill program, picked up both prescriptions each month and continued to take both meds.
The pharmacist contacted the member’s doctor, and the irbesartan was discontinued. The member was very happy that she had chosen to participate in the MTM program. She appreciated reviewing her medicines with a pharmacist, and was pleased she was less likely to feel dizzy or fall again.
Help members avoid expensive and unnecessary medical events
Prime’s MTM program makes a difference. It helps members live well by improving outcomes. It optimizes drug therapy and lowers total cost of care for clients.