There is widespread agreement about the importance of controlling prescription drug costs. One extremely important piece of the solution is to fully enlist pharmacists in optimizing the use of the medications the public and health plans are paying for.
Adverse events and improper use of medications impose heavy health care costs in this country. Patients and consumers are not getting the most out of the medications they are paying for. A patient with multiple chronic illnesses (diabetes, high blood pressure, etc.) will be on multiple medications. Data show that patients on multiple medications have an average of four or more drug-related problems. Fixing those can minimize side effects and avoid adding even more medications to treat those side effects, prevent hospitalizations and the need for further medical care.
At the very least, a pharmacist can reduce drug costs by making sure patients are using the least expensive cost-effective alternative therapy and eliminating duplicate therapies.
Pharmacists are the most under-utilized health care professionals in a health system suffering a shortage of physicians and with patients in need of care. Pharmacists know more than any other health professional about medications and their use.
Pharmacists have a minimum of six years of college education, culminating in a doctor of pharmacy degree, and many have more. They are educated to use a process called medication management to review every medication a patient is taking, using the medical record and working with the patient’s physician to optimize his or her therapy.
Furthermore, pharmacists are the most accessible health care professionals. Ninety percent of Americans live within five miles of a pharmacy, and pharmacies provide the convenience of being open much longer hours than most health care clinics.
The current situation is a highly inefficient use of a national resource of highly trained professionals.
This situation has been recognized in a recent Health and Human Services report on the health care workforce that calls for full use of all health professionals, including pharmacists, working in teams to optimize efficient medical care.
So why isn’t it happening already?
It is to some extent. Some health plans and, in Minnesota, Medicaid will pay for this service for eligible patients. Some primary care clinics have incorporated pharmacists into health care teams. However, not all pharmacies and pharmacists offer medication management, patients don’t know to ask for it and not all physicians know to refer a patient to a pharmacist.
Better education of the public to ask for a pharmacist, combined with legislation insisting that all health plans include payment for medication management, can improve patient health care and contain medication costs.
Bills in Congress would also give pharmacists provider status that would help with payment.
Yes, the service will bear a cost, but the return on investment is better health for patients and less money spent on unnecessary or overly expensive medications. The overall savings have been shown to substantially outweigh the cost.
Marilyn Speedie is dean emeritus, University of Minnesota College of Pharmacy.