A claims professional noted that a patient’s drug regimen included 11 medications, raising serious concerns. However, each individual drug seemed to be prescribed with a legitimate medical need.
How does a claims professional determine when the number of medications in a patient profile is too many?
Polypharmacy is the simultaneous use of multiple medications in an individual patient. While there are instances in which polypharmacy is necessary and appropriate, polypharmacy is often inappropriate and can lead to patient safety concerns and higher costs.
Polypharmacy can cause adverse effects that worsen a patient’s health, putting them at risk of serious harm and even death.1-2 Downstream effects from adverse events can also result in delayed functional improvement and return-to-work.
In addition to increased pharmacy costs resulting from a high number of medications, polypharmacy can trigger adverse drug events that contribute to overall medical costs. For instance, opioid-induced constipation can double total healthcare costs during the first year of opioid therapy.3
Polypharmacy becomes a concern when it contributes to:
Clinical intervention is incredibly beneficial as it can lead to simpler drug regimens, increased patient safety, improved patient outcomes, and reduced costs.
Intervention opportunities include:
