As we approach the end of 2021, it's a good time to look back on the year and identify some of the biggest developments, trends, and stories of the year concerning medications, medication management, and related issues.
Here's our list, in no particular order.
1. Pharmacists take on expanded responsibilities
As the fight against COVID-19 continued into 2021, we saw pharmacists take on expanded roles and greater responsibilities in the delivery of care and support of patients. A column in Pharmacy Times on the subject noted, "Pharmacists are, for example, addressing concerns from especially anxious, fearful patients amid the cold and influenza season. … Pharmacists have also been instrumental in providing patients with reliable information about the prevention, detection, treatment, and management of COVID-19."
In September, the Department of Health and Human Services announced an amendment to the COVID-19 Public Readiness and Emergency Preparedness Act declaration that allowed pharmacists to order and administer select COVID therapeutics.
2. Usage and acceptance of telepharmacy increases
2020 was the year that propelled telehealth, including telepharmacy, into the spotlight and mainstream. We may look back on 2021 as the year that telepharmacy solidified its role as a viable and highly effective means of delivering essential pharmacy services to patients.
Dr. Eric Maroyka, senior director of the Center on Pharmacy Practice Advancement at the American Society of Health System Pharmacists (ASHP), told Drug Topics Journal that telepharmacy has grown exponentially over the past year. "We see it as an opportunity to improve patient outcomes, expand access to healthcare — whether it's an acute or ambulatory care setting — and find that it’s also a way to enhance patient safety. It could in many ways achieve more effective delivery of care as well." In its 2021 Pharmacy Forecast, ASHP recommended the permanent implementation of telepharmacy services.
Another indicator that telepharmacy is receiving increased attention: The Drug Enforcement Administration recently issued an advanced notice of proposed rulemaking for telepharmacy practice.
3. "Pharmacists as providers" picks up steam
2021 saw more progress in the effort to have pharmacists recognized as healthcare providers. Early in the year, Massachusetts was added to the growing list of states recognizing pharmacists as providers, and progress was seen in states such as Nevada and Colorado. In a mid-year update on the matter, the National Alliance of State Pharmacy Associations notes, "So far, 32 bills in 18 states have passed their respective legislatures and been signed into law, and 16 bills in 10 states are awaiting a governor's signature."
This Pharmacy Times column argued for expanding the services pharmacists can provide and be paid for to include chronic disease management, medication therapy management (MTM), patient education, and point-of-care testing.
4. Development of COVID antiviral drugs
COVID-19 remained the top story in healthcare — and the globe — in 2021. One of the biggest medication stories in 2020 was the U.S. Food and Drug Administration (FDA) issuing emergency use authorization for multiple vaccines for the prevention of COVID in December. Nearly a year later, an FDA advisory committee voted in favor of authorizing molnupiravir, an antiviral pill for treating COVID. If FDA authorizes use of the medication, it would be the first oral medication designed to treat the infectious disease.
5. Role of technology grows
The role of technology in healthcare continued to grow in 2021, and that extended to medication management and helping solve its problems. We saw numerous stories like this one in Pharmacy Times, where the author advocated for expanded use of technology to better support effective and safe drug use. The author concluded, "Pharmacists must use data intentionally to prevent medication errors. Using technology in the medication use process in an increasingly interconnected system helps achieve the common goal of effective and safe medication use."
Meanwhile, this column in HealthTech Magazine pushed for national medication management reform driven by actionable data that can empower care teams. This column in Pharmacy Times discussed the increasingly important role of technology in helping pharmacists and healthcare providers better ensure more effective and safe medication use while this Pharmacy Times column explained why a tech-enabled pharmacy is essential to "unlocking" the abilities of pharmacists to deliver care.
6. Research validates the importance of CMM services delivered by pharmacists
Researchers from the University of Minnesota, University of North Carolina, American Board of Family Medicine, and the American Academy of Family Physicians demonstrated that comprehensive medication management (CMM) delivered by a pharmacist supports and aligns with the foundational elements of primary care.
As one of the authors, Kylee Funk, noted, "The results of our work demonstrate that CMM delivered by a pharmacist both supports and aligns with the foundational elements of primary care. These are important findings as the healthcare community looks to best integrate pharmacists as key members of an interprofessional team."
7. Appreciation for and performing of deprescribing surges
In a 2018 Journal of Pharmacy Practice and Research article, the author noted, "It is obvious that the deprescribing movement, however meritorious, is unfortunately still struggling to find widespread traction, a notion that is difficult to grasp in a context of evidence‐based medicine."
Fast-forward to 2021 and the deprescribing movement is picking up steam. Not only are more clinicians embracing deprescribing, but more research is being performed about it as well. There's research such as this published by the National Institute on Aging; this published in JAMA Network Open, and this in BMC Geriatrics that looks at deprescribing decisions across 31 countries. The New York Times also examined polypharmacy trends and explored the increasing usage and benefits of deprescribing.
This is all good news as deprescribing — when it's supported by access to a patient's current, comprehensive medication list that includes drug information from all prescribers and retailers — is one of most effective ways to safely decrease inappropriate and unnecessary polypharmacy.
8. Research further validates value of medication management
Numerous studies and research were published in 2021 that further support the critical need for personalized, data-driven medication management services, including medication reconciliation and deprescribing. For example, research out of the University of Buffalo revealed a startling statistic: Nearly every adult 65 and older was prescribed a prescription drug that increased their risk of falling in 2017. The study determined the percentage of such adults had risen to 94% from 57% (still rather high) in 1999. Furthermore, the research showed that the rate of death caused by falls in older adults more than doubled during the same period.
As Amy Shaver, PharmD, the study's lead investigator, noted, "Our study indicates two trends increasing concurrently at a population level that should be examined at the individual level. Our hope is it will start more conversations on healthcare teams about the pros and cons of medications prescribed for vulnerable populations."
As another example, research revealed that many hypertensive patients may be inadvertently taking medications that raise their blood pressure, which points to the need for clinicians supporting these patients to screen for such medications and look for deprescribing opportunities.
9. Data show medication adherence reduces costs … a lot
A detailed CMS report estimated that many billions of dollars in healthcare costs were avoided for Medicare beneficiaries between 2013 and 2018 thanks to improved patient adherence to medications for diabetes, hypertension, and cholesterol. As a Pharmacy Times article on the report noted, CMS also found that more than 3 million more Part D beneficiaries with complex health needs than expected between 2013-2018 received a comprehensive medication review as a part of medication therapy management.
10. Poor care team communication identified as a top CMM obstacle
A survey of healthcare leaders by the Get the Medications Right (GTMRx) Institute of more than 200 healthcare leaders on the biggest issues facing the industry found that nearly 80% of respondents strongly believe that access to team-based, person-centered comprehensive medication management services will "ensure a safer, more effective and appropriate way to manage medications and avoid medication misadventures."
However, more than 40% of respondents identified lack of communication between prescribers and pharmacists as the biggest issue that will prevent successful patient medication management.
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