It’s a classic, if extreme case: a patient died. This particular patient was undergoing treatment for, among other things, rheumatoid arthritis, under the care of a physician. He contracted an infection, for which the physician prescribed amoxicillin; he was also given leflunomide (another drug used to treat RA). When his RA continued to get worse, the patient doubled his weekly dose of (previously prescribed) methotrexate without telling his doctor. This increased dose negatively interacted with the new medications, and he was dead within days.
Adverse drug reactions (ADRs) caused either by individual drugs or drug combinations are one of the top 10 causes of death in the U.S. today, and over 20% of those reported ADRs are due to interactions of co-administered drugs.
If you’re a group health benefits advisor, it’s important to stay current on this topic — understanding how to effectively use the available data can help promote healthier outcomes for your members, reduce potentially harmful or dangerous acute care episodes, and cut overall health related costs.
Even if you have only limited involvement in health insurance sales or no involvement at all, you should know something about this topic because, in an age of pharmaceutical cornucopia, where individuals may be on multiple medications to treat a variety of morbidities, it is important to make informed and empowered decisions regarding one’s health. Increasing collaboration, transparency, and sharing knowledge with health care practitioners will only serve to benefit one’s overall well-being. We can all get sick, and can be subject to the possibility of a negative drug interaction.
So, while the above patient’s story is certainly a worst-case scenario, ADRs are by no means uncommon. While not always deadly, those negative drug interactions lead to numerous emergency room visits and hospital stays, and can affect not only a person’s health for years to come, but also their professional care networks – from pharmacists, to physicians, to other members of the health care system.
Pharmacists and providers typically exist in separate spheres. Each only has access to their own, limited information about a patient’s medication, and shares little of what they know. Only the payer has access to the full picture of the patient’s care from the data generated by that care. The challenge we’re facing is how to get pharmacies, providers, and payers to be able to work together collaboratively to better manage care for patients with comorbidities and multiple medications, to ultimately avoid ADRs.
Multiple barriers stand in the way of sharing this necessary information, however. To begin with, while payers have access to the raw data, most can only do so much to review, synthesize, analyze, and, ultimately, share it. A payer’s database is the singular location where all of the patient’s claims are aggregated – in contrast to hospitals, physicians, or independent pharmacies that may only have access to their respective slice of that information. To further complicate this, it’s not at all uncommon for a patient to receive prescriptions from more than one source (PCPs, specialists, urgent care, etc.) in more than one health system, and filled in more than one pharmacy. The increasing presence of polypharmacy further narrows the chances of one pharmacy having access to a complete patient medication history. Even some patients themselves might not have access to or awareness of this information. Without easy and comprehensive access to payer data, how can any single pharmacy have the knowledge necessary to intervene at the point of sale to prevent ADRs?