By Susan Dentzer, Senior Policy Fellow, Duke-Margolis Center for Health Policy
June 8, 2020
Yet Another Reason to Get the Medications Right
Add to the long list of reasons to “get the medications right” the COVID-19 pandemic. It’s clear that the fight against the SARS-CoV-2 virus will include an arsenal of therapies to combat the virus and its devastating effects on the body. This reality affords a clear rationale for comprehensive medication management, perhaps as never before to the same degree.
As of this writing, the U.S. Food and Drug Administration has issued emergency use authorizations (EUAs) for one new antiviral drug—remdesivir—and for Fresenius Propoven, a sedative to treat patients on ventilators. (An EUA for the use of hydroxychloroquine and chloroquine was issued temporarily, then revoked amid mounting evidence of lack of their effectiveness in treating COVID-19). The FDA also has allowed antibody-containing convalescent plasma to be administered to those with life-threatening COVID infections. Other therapies and vaccines are in development and undergoing clinical trials.
What’s more, as the virus wreaks its havoc on the body, many patients with COVID-19 need treatment with antithrombotic, anticoagulant or antiplatelet agents to combat potentially deadly inflammation and thrombosis. Many of those who are most affected have multiple conditions that require an array of medications, including statins, ACE and ARB inhibitors and NSAIDs.
How are all these therapies being managed for today’s COVID patients? Are they being managed? And how will an even greater range of treatments be managed in the future? Debates over the appropriate use and effectiveness of COVID therapies will continue to grow as more products come on the market. The risk of drug-drug interactions will be high, and in some cases, a patient’s genetic makeup may render certain treatments ineffective or even deadly.
Now is the time
All these factors create a compelling mandate for comprehensive medication management in the context of COVID, its aftermath and the multiple other conditions affecting patients. Consider the implications across the four key domains of the GTMRx Institute’s efforts: Practice and Care Delivery Transformation; Health IT and AI; Payment and Policy; and Precision Medicine. Each area will have a clear COVID mission in the months, and possibly years, ahead.
Practice and care delivery transformation
Practice and care delivery transformation arguably has the heaviest immediate lift as cases of COVID continue to mount. In many parts of the country, inpatient management of medication must be tracked by teams that are already exhausted and overstretched.
Given COVID’s lingering effects, including strokes and neurological deficits, the need for outpatient medication management will be substantial. This need arises at a time when the spread of infection and cancellation of much in-person care has reduced direct care access for many patients. In some respects, these developments will only increase the challenges of executing on CMM. But on the other hand, the opportunities have increased as well, particularly with respect to more virtual forms of health care such as telehealth. Imagine how a clinician conducting a follow-up visit with a recovering COVID patient over Zoom could now have a pharmacist on the care team easily and seamlessly weigh in.
Similarly, health IT also has a robust role to play in CMM during the pandemic. Especially in the short-term, interoperability of EHRs will be critical as COVID patients potentially move from one care site to another, including care via telehealth.
There have already been calls to speed up implementation of interoperability rules finalized by CMS and the Office of the National Coordinator for Health IT—and, in particular, to hasten the rapid adoption of standard application programming interfaces (API) for EHRs, which will allow for faster and more scalable access to health information. Such measures will advance the cause of medication optimization now, during the pandemic and well into the future.
New payment models
The health care system needs to adopt new payment models to support CMM, appropriate use of telehealth and team-based care. This goal has become more urgent amid the pandemic, and it will remain so as the health care system begins the long road back to financial recovery.
Opportunities also abound for precision medicine and advanced diagnostics to be part of the COVID response, given everything from the variability of patients’ responses to the virus, to the potential emergence of new genetic variants of SARS-CoV-2 in the future.
Avoiding unnecessary deaths
With the United States approaching nearly 3 million documented SARS-CoV-2 infections as of this writing and more than 130,000 COVID-19 deaths, curbing the spread and successfully treating patients is the nation’s most immediate challenge. But reducing illness and death from non-optimized medication use—especially amid the pandemic—is not far behind.
COVID-19 has both revealed the failings of our current approach to health care delivery and spotlighted the tremendous opportunities for improvement. The disease is forcing all stakeholders—including payers, health systems, regulators, health IT vendors and others—to adopt innovative approaches to diagnosis, treatment and management of populations. The nation can’t afford to waste this opportunity to make comprehensive medication management a permanent cornerstone of our health care.