Sponsored - Medication nonadherence – patients taking medication sporadically or not at all – is a costly problem in the US. In fact, it’s estimated that missing or skipping prescribed drugs costs upwards of $300 billion and causes more than 275,000 deaths each year.
Non-compliance with prescribed medication happens for a number of reasons, including medication costs, forgetfulness, vision issues, and understanding dosage and timing. All of these are extremely preventable, which is why pharmacies and insurance companies are starting to implement a system called medication therapy management, or MTM. It is defined as program used to help patients manage medications and health conditions, immunizations, and health and wellness programs.
Implementing your own MTM program is best done through your local, independently owned pharmacies, like Paul’s Pharmacy in Evansville, IN. Laura Ziliak, a pharmacist at Paul’s, said that as a pharmacist, “You want to have the best outcome for your patient. So when they’re taking their medications, compliance is huge.”
One way to make sure patients are compliant with their medication schedule is medication synchronization, or med sync, which is something favored by pharmacists and insurance companies alike. According to pharmacist Jon Robb, Paul’s Pharmacy works to establish a single date each month for patients to pick up all of their medications. That ensures patients have all of their medicines at all times.
However, it’s not a foolproof way to make sure patients take their medications. “Insurance companies like it because everyone’s compliant, even though we may be filling them every month and they might not be taking it, we don’t know,” Robb said. “It is good for the customers who have a lot of meds who don’t want to come in to the pharmacy but once a month or once every three months.” If a patient gets a new medicine on a day that is off-cycle from their med sync day, an independent pharmacy can work around that by short-filling the prescription (only filling part of the full prescription) in the meantime, and filling the rest with the other prescriptions on file.
Another reason to work with an independent pharmacy on establishing MTM is cost. While it might seem costly to fill all prescriptions on one day, a pharmacist has access to a number of cost-saving devices to help ease co-pay or co-insurance costs.
Ziliak said, “We have a lot of low-income patients, so getting them all at the same time might be expensive, depending on when they perhaps get a social security check or their payday. So we can help them with that. If they have an expensive medication, let’s get it at the first of the month, every month, when they have the money to pay for it.”
“Again, that’s about compliance and getting the best outcome for the patient so that they don’t end up in the in the hospital because they couldn’t afford that medication.”
Saving money on medication can make a huge difference to someone on a fixed or limited income, and that’s something the pharmacists at Paul’s take into consideration when helping their patients. “If you save someone $500 a year, now there’s a supplement that they should be on that’s over the counter, but they couldn’t afford it, so now they can buy it. I always say if you’ve got something better to do with that $500 a year than spend it on a brand-name medication, whether it be for your health or whatever,” Ziliak said.
At Paul’s, the pharmacy team is always looking for ways to make sure their patients have all of the medication they need at the most affordable price, which means knowing where and how to fill manufacturer coupons. While it’s difficult to find prescriptions that qualify for coupons for Medicare Part D patients, pharmacists have access to all the money-saving apps and rebate programs that help lower medication costs.
“We have access to all those cards and we can look them up and sign the patient up, or we can have them sign up to get the card, and we can run that card for them,” said Robb. “That takes their copay down from $400 to $10 on expensive medications, like Eliquis. Someone with private pay insurance their copay may be $120 a month, but there’s a copay card out there that will take it down to $10.”
That savings can mean fewer hospitalizations and better health for the patients. The proportion of deaths occurring due to medication mismanagement among the elderly is significant, with 75% of Americans between ages 50-64 taking some form of prescription drug, and 91% of those ages 80 and older.
Working with an independent pharmacy is especially helpful for older adults and the elderly, who might need extra attention when filling their prescriptions.
“The elderly patients are a big part of our business. They need the extra time, and they can’t be rushed,” said Ziliak. Most elderly adults take more than four prescriptions a day. That leaves a lot of room for error in their medication compliance, which in turn leads to more hospitalizations, somewhere around 200,000 per year.
“They have hospitals that change medications, and we have the time to sit there and talk to them or to follow up with them, and we also have the opportunity to work with their families. We offer all these different services that others don’t offer.
“We offer strip packaging medications to make it simple for caregiver or family member to make sure they are actually giving the right meds. We deal with families that live across country, and they’re trying to help their elderly parents so we offer delivery to make sure they get their meds,” said Ziliak.
The strip packaging, called Paul’s Packs, are personalized medication pouches that are packed and labeled with medications by time of day, and make taking multiple medications easier and safer. Caregivers and family members can give medications at the right time in the right doses, and also tell if their family members have been taking the medication on a regular basis.
Other benefits to MTM through a local pharmacy include good working relationships with the pharmacists and doctors. In some cases, pharmacists are better informed about the real costs of medication than doctors.
“Doctors don’t know what medications cost, so if they put someone on a brand-new medication and it’s expensive and there’s a generic available that’s cheaper for them, we can pick up the phone and call the dr. and let them know,” said Robb.
“Or we can switch to a therapeutic equivalent,” said Ziliak. “(We can) call the doctor and switch it to something that is covered on their plan. And not just send the patient out the door and say, ‘I’m sorry it’s $400.’ We have so much access to professionals that we work with, whether they be nurses or at clinics, people that we know, when people just need that extra help on what services are out there.”
That personal touch extends beyond just medication therapy management and into the full life of the patient.
“We’re more about being proactive,” said Ziliak. “I’m a big encourager that if we can be proactive and use supplements and not be on medication, 100%. That’s an area we encourage overall health. I’m not afraid to tell people if you walk 15 minutes a day, that might get rid of your cholesterol medication, and that’s the one that’s causing you so many aches and pain.
“Sometimes they need a nudge from someone who is not a family member. There have been situations we’ve suggested alternative therapy, physical therapy, exercise to get them off of medication. We’re not about putting people on medications. We want them on the least amount of medication possible.”
That is why MTM works well at a local pharmacy, according to Ziliak. “I think just getting to know the patient gives you the bigger picture. Is this patient under a ton of stress? Are they taken care of? Do we know the background why are they on all of this (medication)? And it may be just something they’re going through
“Physicians don’t write on prescriptions what their diagnosis is, and the only way you know what that prescription is being used for is if you talk to the patient and see what the diagnosis is. People are willing to talk to pharmacists. That’s what MTM is , it’s seeing patient as a whole person., what’s going on in their lives, what’s happening with their medications.”
If you or someone in your family is on several medications for different health conditions, or are finding it difficult to manage the number of prescriptions, call or visit your local pharmacy, like Paul’s Pharmacy, to get started on your own Medication Therapy Management program.
