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Katherine Capps

Katherine H. Capps
Executive Director
GTMRx Institute

Part 2 of a three-part series for employers to lower costs and improve outcomes by getting the medications right. Part 1 can be found here.

July 31, 2019

Last month at the Public Sector Healthcare Roundtable’s 2nd Annual Congressional Forum, I shared a salient question at the heart of not only lowering prescription medication costs, but improving health outcomes: Is this the right medication for this person?

For employers and public sector payers, as well as for consumers, the economics of getting the medications right are compelling.

We’re wasting $528 billion—or 16% of the total annual U.S. health care spend—for additional medical resources used to resolve problems attributable to inappropriate use of medications. We’re paying for additional medications, emergency department visits, hospitalizations and provider visits because we didn’t get the medications right the first time.

Medications are involved in 80% of all treatments and impact every aspect of a patient’s life. Nearly 30% of adults in the U.S. take five or more medications. The choices for physicians are overwhelming; they’re choosing from among 10,000+ prescription medications when they write a prescription.

And yet, our health care system is not set up to ensure appropriate use of medications. We have a trial-and-error system of medication use that leads to
  • Wrong prescription choices
  • Skipped doses
  • Medication that doesn’t work
  • Medication that makes people sicker
  • More health care resources consumed
  • Waste, waste and more waste.

We can’t keep playing a game with this many losses—in quality of life, decreases in employee productivity, and life itself. More than 275,000 people die each year due to non-optimized medication use.

The $528 billion opportunity is ours for the taking. We can tackle waste by implementing the systematic approach to medication use that we call comprehensive medication management (CMM).

With CMM, physicians and pharmacists ensure that medications (whether they are prescription, non-prescription, alternative, traditional, vitamins, or nutritional supplements) are individually assessed to determine that each is
  • appropriate for the patient,
  • effective for the medical condition,
  • safe given the comorbidities and other medications being taken, and
  • able to be taken by the patient as intended.

This team-based, comprehensive approach will become even more important as new companion and complementary diagnostics, such as pharmacogenetic panel testing, enter the clinical mainstream.

Comprehensive medication management is the delivery system disruption we need to allow research and discovery to flow to the practice level—the bedside, the exam room and in the community—to unleash the innovation we need to lead our healthiest lives.

If you are a physician, pharmacist, employer, consumer advocacy group, health system, payor or solutions provider, we encourage you to join our work designed to get the medications right!

Tune in on August 14 for part 3 in this 3 part series.

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