Medication Management: 2019 Year in Review

As we approach the end of the year, let’s examine some of the most significant news and developments concerning medication management in 2019.

1. Significant challenges remain

But there is good news.

2. More viable tools and solutions are hitting the market

Technology companies, recognizing the tremendous opportunities that exist to help improve medication management, continue to introduce new tools intended to help providers and patients with medication management. Early in the year, Medisafe (which we spotlighted last year) launched Mediscoveries, a new program that shares insights into medicine management behaviors and drug efficacy. Propeller Health began the year by launching a feature in its Propeller app that connected users with asthma and chronic obstructive pulmonary disease to pharmacy services from Walgreens and recently announced an expansion that now also includes CVS, Walmart, Kroger, and Rite Aid. Even Amazon got into the medication management game, recently announcing the addition of a new feature to its Echo/Alexa solution that reminds Giant Eagle Pharmacy customers when to take their medications.

And, of course, we’d be remiss if we didn’t mention the launch of Cureatr’s own medication management solution, Meds 360°, which provides caregivers with easily accessible, real-time prescription fill data, past and present, in an easy to read, comprehensive view, and can be sorted alphabetically, by drug categories, last fill date, and more.

This year, we also witnessed solutions that have been on the market for some time, gaining more traction and usage. This will only help their developers strengthen the products and hopefully make an even greater, positive impact on medication management.

3. Continued surge of telehealth

The use of telehealth is growing and is making a substantial mark on much of healthcare, including medication management. Telehealth was all over the news in 2019 as more organizations adopted and began using telecommunication technologies. Earlier in the year, FAIR Health issued a report that showed national utilization of telehealth grew by 53% from 2016 to 2017. This figure is significantly higher than any other place of service studied for that variable in the report, which examined national insurance claims filed for alternative settings of care.

Later in the year, FAIR Health released a white paper showing that private insurance claim lines for non-hospital-based provider-to-patient telehealth grew nearly 1,400% from 2014 to 2018.

Telehealth’s impact on medication management was felt nationwide this year. We learned about the Oklahoma Health Care Authority leveraging telehealth to enhance medication management for Medicaid patients, the director of the pharmacy for North Carolina Specialty Hospital in Durham using a telepharmacy service to help patients on nights and weekends, and the Hospice of Santa Cruz County creating a telehealth platform to provide a range of services to patients requiring palliative care, including medication management.

Despite some challenges impeding telehealth adoption, telehealth seems to show no signs of slowing down.

4. Slow progress — but progress nonetheless — on opioid epidemic front

In 2017, the opioid epidemic was declared a public health emergency, and rightfully so. Opioid prescribing has increased dramatically over the past dozen-plus years. The U.S. Department of Health and Human Services (HHS) reports that about 130-plus people die daily from opioid-related drug overdoses, and more than 10 million people misused prescription opioids in 2018. From 1999 to 2017, more than 200,000 people died in the United States from overdoses related to prescription opioids. 

On a positive note, 2019 looks to have been another critical year in the battle to defeat the opioid crisis.

Among the highlights:

• HHS announced an additional $1.8 billion in funding to states to combat the crisis.
• A swath of lawsuits and settlements against the likes of drugmakers and pharmacies is generating billions of dollars in additional community support.
• Purdue Pharma, the maker of OxyContin, filed for Chapter 11 bankruptcy and may become an “entity focused on manufacturing and distributing overdose antidote drugs free or at a low cost to communities hit hard by addiction.”
• There’s new research on a promising alternative to opioids.
• Federal and state funding is going to companies working to help in the battle.
• New technology and partnerships between companies are assisting prescribers in making smarter decisions concerning opioids.
• Proposed tightening of federal rules for opioid manufacturers was announced.

There is reason to believe that this positive momentum will continue into and through 2020.

5. Drug prices continue to frustrate and create obstacles to adherence

The high cost of medications remained a challenge for patients and prescribers this year. While there are efforts on federal and state levels to get rising prices under control, including a bill recently passed by the House, it’s difficult to know when patients will experience any significant relief.

As a CBS News report notes, more than 3,400 drugs experienced an increase in their prices in the first six months of 2019. That represents a growth of 17% compared to the number of drug hikes from 2018. The average price hike in those first six months: 10.5%, or five times the inflation rate. More than 40 drugs more than doubled in price. Reports of high and rising prices are alarming since it has been shown that cost plays a significant factor in medication adherence and efforts to achieve effective medication management.

An AARP report on specialty drugs — those used to treat complex, chronic conditions — stated that in 2017, retail prices for nearly 100 of these medications increased by an average of 7%, or more than three times the overall inflation rate. The average annual price for just one of these specialty medications: close to $80,000. Considering many older patients take multiple medications, the yearly cost of medications can be staggering.

As Leigh Purvis, director of health services research at the AARP Public Policy Institute notes,

“If these trends continue, older Americans will be unable to afford the specialty prescription drugs that they need, leading to poorer health outcomes and higher healthcare costs in the future.”

6. New medications

Every year, numerous new medications come to the market. Many of these can support clinician efforts to improve medication management for their patients. New medications can help prescribers improve treatment, reduce a patient’s number of medications (potentially helping with polypharmacy risks), and combat side effects that may contribute to medication nonadherence. Of particular note, there have been 42 novel drug approvals for 2019, along with the dozens of non-novel drugs approved thus far. We’re already looking forward to several novel drugs likely to receive approval in 2020, including medications for Alzheimer’s, HIV, multiple sclerosis, and breast cancer.

With all that said, it is important to note that new medications can create challenges for medication management, including increasing the difficulty of following and adhering to a regimen. These challenges are magnified when a patient is prescribed a new medication that alters their current regimen; does not lead to the removal of any medications from the current regimen (potentially contributing to polypharmacy risks); causes undesirable interactions and side effects, and/or creates a more significant financial burden.

7. Collaborative practice agreement advances

Going into 2019, there were only two states that did not permit any form of a collaborative practice agreement (CPA) between pharmacists and other providers. CPAs, also referred to as a collaborative pharmacy practice agreement, consult agreement, physician–pharmacist agreement, standing order or protocol, and physician delegation, are, according to the American Pharmacists Association, used to “… create formal relationships between pharmacists and physicians or other providers that allow for expanded services the pharmacist can provide to patients and the healthcare team. CPAs define certain patient care functions that a pharmacist can autonomously provide under specified situations and conditions.” 

As we previously noted, CPAs can deliver many medication management benefits, including enhancing collaborative care delivery efficiency and effectiveness. 

In August, Alabama became the 49th state allowing some degree of CPA, when the state’s governor, Kay Ivey, signed a bill into law that authorized a pharmacist and physician licensed by the state to enter into a CPA. In a Samford University news release about the passage of the law, Michael Crouch, dean of the McWhorter School of Pharmacy, states,

“Alabama pharmacists — through collaboration — bridge the physician shortage gap in the state, and this law is a key step toward pharmacists providing care through a full scope of practice.”

Delaware remains the only state not permitting any CPAs.

There was also progress made on expanding CPAs. For example, Florida came one step closer to approving a new CPA law. As ASHP notes, 

“Current state law allows pharmacists in hospitals and skilled nursing facilities to provide comprehensive medication therapy management services under a physician-approved protocol. But in other settings … a pharmacist must obtain authorization from the patient’s physician for any change to the medication regimen.”

The new law, which cleared the state’s House Health Care Appropriations Subcommittee in May, would permit a physician to “… consent to a collaborative arrangement for the treatment of certain pre-defined chronic conditions,” notes Florida Politics. Furthermore, “That agreement would allow pharmacists to make treatment decisions in certain cases, such as supplying a diabetic patient who has run out of insulin.”

Medication Management in 2020

Despite the numerous obstacles clinicians face in their efforts to deliver comprehensive medication management services, we are optimistic that such efforts will become easier in 2020. The increased national focus on healthcare in general and medications more specifically, coupled with significant advances in and support of new medication management-related technologies and solutions, should help clinicians make smarter, more personalized, and effective decisions concerning medication management. This can only help to improve medication adherence and overall outcomes.

Another encouraging development is the building momentum for personalized, team-based medication management championed by the Get the Medications Right Institute (GTMRx), a non-profit organization whose mission is to bring critical stakeholders together, bound by the urgent need to optimize outcomes and reduce costs by getting the medications right. Just six months after its launch, the GTMRx Institute announced it “…has tripled its annual membership goal,” growing to 600 members strong. 

While we don’t necessarily expect 2020 to be a transformative year for medication management, we hope to be able to write that it was a positive year overall when we revisit this blog next December.

Note: Think we missed any big news? Have anything to add to our analysis? Share your thoughts in a comment below.