As we approach the end of 2020, let's look back at nine of the most significant facts and figures defining the year that was for medication management.
1. A year defined by COVID-19
We'll address the elephant in the room first. The public health crisis has undoubtedly affected medication management and adherence, as well as all other aspects of healthcare, in ways that will take years to fully understand and appreciate. Two articles help paint the picture. In April, Pharmacy Times published an article titled "Concerns About Medication Adherence Grow Amid COVID-19 Pandemic" that noted, "Medication nonadherence is an issue in the best of times." Then, earlier this month, the American Medical Association (AMA) reminded us about reasons patients don't take their medications, which include cost, depression, and mistrust — just three of the challenges that have surged due to the pandemic.
Prior to COVID-19, we were witnessing gradual but notable improvements in medication management and adherence. Despite commendable efforts to reduce the negative effects of the health crisis on health and wellness, in areas including medication management, the pandemic has undoubtedly set us back a bit.
On a positive note, we'll enter 2021 with at least one vaccine having received an emergency use authorization.
2. More than 14% of persons
In February, the National Center for Health Statistics published a data brief concerning problems with paying medical bills, which includes medications and several other expenses (e.g., bills for doctors, dentists, hospitals, therapists, equipment). There was actually some good news in this report as the researchers noted that the percentage of persons who were in families having problems paying medical bills in the past 12 months decreased from close to 20% in 2011 to about 14% in 2018. Unfortunately, the developments of 2020 are sure to reverse this positive trend for reasons that include an unemployment rate 3.2 percentage points higher in November than it was pre-pandemic.
3. 33% increase in price
In September, GoodRx published new research on pricing trends for medical goods and services from 2014 into 2020. While all medical services combined have increased by about 17% during this period, prescription drug prices have increased by 33%, outpacing price increases for any other medical commodity or service. When you combine rising drug prices with increases in job losses and other factors straining Americans financially, it's not surprising to hear that more people are struggling to pay for their medications.
4. More than 1.1 million deaths
The inability to afford prescription medications could lead to the deaths of more than 1.1 million Medicare patients over the next decade, according to the results of a study published by the West Health Policy Center in November. As a news release on the study notes, the estimated 112,000 annual premature deaths of beneficiaries would make it a leading cause of death in the United States, ahead of diabetes, influenza, pneumonia, and kidney disease.
Timothy Lash, president of West Health Policy Center, stated, "One of the biggest contributors to poor health, hospital admissions, higher healthcare costs, and preventable death is patients failing to take their medications as prescribed. Cost-related nonadherence is a significant and growing issue that is direct result of runaway drug prices and a failure to implement policies and regulations that make drugs more affordable."
5. Nearly 3,000% claim lines
Telehealth claim lines — defined as individual services or procedures listed on insurance claims — increased nearly 3,000% nationally from September 2019 to September 2020, rising from about 0.2% of medical claim lines in September 2019 to 5.1% in September 2020, according to FAIR Health data. While we do not know how many of these claims include medication-related services, it is safe to assume that telepharmacy has cemented its place as a viable method of delivering medication management services.
As pharmacy expert James Jorgenson, RPh, MS, FASHP, stated, "Considering the current pandemic, the use of telehealth and telepharmacy makes even more sense. We're seeing the successful execution of remote order entry and verification, remote medication reconciliation, remote counseling and education, and remote dispensing being used routinely. Pandemic or not, I think this will become the new normal. After the pandemic subsides, we're not going to go back to the old ways of delivering many of these services."
6. More than 200 drugs
At the time of publication, there are more than 200 drugs currently experiencing a shortage, reports the American Society of Health-System Pharmacists. The AMA reports that the pandemic contributed to a spike in shortages, notably in analgesics, sedatives, and paralytics because of the need for many patients with COVID-19 to be put on ventilators.
Drug shortages have always created medication management challenges. That continued in 2020 and will undoubtedly carry over into 2021 and well beyond.
7. Increased attention on "medication overload"
Early in the year, the Lown Institute issued a report titled "Eliminating Medication Overload: A National Action Plan." The report, which received the endorsement of a number of organizations, including the Institute for Healthcare Improvement, Kaiser Permanente, and the Pharmacy Quality Alliance, and had its value affirmed by the American Geriatrics Society, drew more attention to the concept of "medication overload."
The report defines medication overload as: "… the use of multiple medications that pose a greater risk of harm than benefit. There is no strict cutoff for when the number of medications becomes harmful, but the more a person is taking, the greater their likelihood of experiencing harm, including serious, even life-threatening adverse drug events." This term differs from polypharmacy in that polypharmacy is not necessarily a negative concept (polypharmacy can prove advantageous) and tends to be associated with a specific number of medications (e.g., at least five).
Considering the challenge presented by medication overload and the significant harm it causes, hopefully it will receive the increased attention it deserves as put the public health crisis behind us. In fact, in 2019, the Lown Institute referred to medication overload as a potential crisis of its own, stating, "Without swift action to reduce medication overload, we face a severe public health crisis in the near future. The rates of prescription drug use and adverse drug events have both increased dramatically over the past decade. Additionally, the U.S. population is rapidly aging, putting at least 20 million more people at risk of medication overload over the next decade."
8. More than one-third of adults age 65 and older
In October, the University at Buffalo (UB) announced the results of a study showing that more than 34% of adults age 65 and older were prescribed potentially inappropriate medications. The study, which was published in the Journal of the American Geriatrics Society, revealed that the prescribing of problematic drugs is linked to increased hospitalizations and costs patients, on average, more than $450 per year.
The study brings increased attention to the emerging concept of deprescribing, which can be defined as "… the process of tapering, stopping, discontinuing, or withdrawing drugs, with the goal of managing polypharmacy and improving outcomes." As Dr. David Jacobs, lead investigator and assistant professor of pharmacy practice in the UB School of Pharmacy and Pharmaceutical Sciences, noted, "Deprescribing is currently at an early stage in the United States. Further work is needed to implement interventions that target unnecessary and inappropriate medications in older adults."
9. Greater appreciation for pharmacists
A silver lining of the pandemic is that it has further revealed the substantial value and importance of pharmacists in supporting medication management efforts while also shining a spotlight on the unnecessary limits placed on pharmacists and their ability to support patients. During the health crisis, pharmacists have been called upon to help fill numerous gaps in the delivery of patient care, providing a wide range of services that include medication management advice, management of drug shortages, the ordering and administering of COVID-19 testing, development of treatment protocols, and antimicrobial stewardship. Pharmacists will soon play a pivotal role in administering the COVID-19 vaccine.
As an article in Preventing Chronic Disease, a peer-reviewed journal established by the CDC's National Center for Chronic Disease Prevention and Health Promotion, states, "During this pandemic, and in past pandemics, the importance of community pharmacies and pharmacists in public health and the health of their patients has been evident. It is imperative that systematic evaluation and dissemination of pharmacists' contributions be undertaken to determine areas where community pharmacy can best be incorporated into the way public health is operationalized and carried out in the United States."
Despite such growing recognition and appreciation of pharmacists, they still find themselves hamstrung by a lack of federal provider status and many state restrictions. As Pharmacy Times reports, only 37 states allowed pharmacists to qualify as medical providers under the rules of Medicare Part B as of October. Without provider-status recognition and a compensation model, pharmacists face roadblocks that ultimately jeopardize patient health and wellness.
These restrictions prompted Dr. Rose Abraham, director of clinical pharmacy operations for Cureatr, to state, "We need provider status for pharmacists so they can be reimbursed for the many important services they are providing. There is no reason to wait to grant provider status to pharmacists. It was the right thing to do before COVID-19. It's even more important now. It's time to remove that obstacle."
Momentum looks to be building for such a change. Hopefully 2021 will be the year when it's finally made.