VA: Millions of potentially inappropriate medications deprescribed
A 10-year review found that the Veterans Health Administration’s VIONE program resulted in more than 4.3 million potentially inappropriate medications being deprescribed among more than 1.5 million veterans from 2016 through July 2026. (VIONE stands for Vital, Important, Optional, Not indicated, and Every medication has an indication.) Estimated annualized cost avoidance: $479 million, according to findings published in Federal Practitioner. More than 29,000 clinicians have used the program, which addresses polypharmacy by prompting clinicians to classify medications as vital, important, optional or not indicated and ensure every medication has an indication. (Federal Practitioner)
AHA calls deprescribing key component of cardiovascular care
Physicians should direct deprescribing decisions for patients with cardiovascular disease and polypharmacy, supported by pharmacists and other members of the clinical team, according to a new American Heart Association scientific statement. The guidance recommends structured medication review, shared decision-making and careful monitoring to identify and address potentially inappropriate medications. The AHA says multidisciplinary approaches can help optimize medication regimens and reduce medication burden. It calls for integrating deprescribing into standard, high-quality, patient-centered cardiovascular care. (Circulation)
Practice Transformation
Employers leave largest PBMs amid cost, transparency concerns
Employers are increasingly moving away from the three largest PBMs, according to a survey of 408 employers by the National Alliance of Healthcare Purchaser Coalitions. The share contracting with CVS Caremark, Express Scripts, or Optum Rx fell from 63.4% in 2025 to 54.3% in 2026. Among employers using the three largest PBMs, 55.7% are considering switching within three years. These employers reported higher-than-average premiums and fewer contractual protections than those using smaller PBMs. Employers ranked PBM reform as their top policy priority, citing concerns about transparency, rebates, and spread pricing. (Modern Healthcare; MedCity News)
Pharmacist-physician network supports HF medication optimization
A pilot pharmacist-physician collaboration for heart failure care resulted in 80 medication-related interventions among 34 patients, 30 of which were accepted. Heart failure-certified community pharmacists partnered with local cardiology practices, reviewing therapy and making recommendations to physicians and advanced practice providers, who retained prescribing authority. Interventions included guideline-directed therapy optimization, adherence support and discontinuation of medications that could worsen heart failure. Researchers plan to expand the model, incorporating primary care physicians and standardized processes for medication initiation, titration and follow-up. (JACC: Advances)
Evidence & Innovation
CMM identifies thousands of medication therapy problems in specialty care
Comprehensive medication management can be successfully integrated into specialty care, according to a study published in the Journal of the American Pharmacists Association. A large academic health system expanded CMM into dermatology, gastroenterology, and rheumatology clinics, where 2,856 patients completed 5,218 pharmacist visits. Pharmacists documented 3,759 medication therapy problems, with the need for additional medication therapy accounting for 45%; 94% of recommendations were accepted. Researchers concluded that integrating CMM pharmacists into specialty clinics can help address health maintenance needs, resolve medication therapy problems, and optimize treatment. (JAPhA)
Policy Solutions
Community pharmacy PGx alerts lead to medication changes
Pharmacogenomic clinical decision-support alerts embedded in community pharmacy systems could provide an additional safeguard, according to a small study in the Journal of the American Pharmacists Association. Researchers evaluated alerts generated across 14 community pharmacies in one health system. Among 11 clopidogrel alerts requiring pharmacist review, pharmacists intervened in eight cases, resulting in three medication changes. Overall alert acceptance was 23%. The study addresses an important implementation gap because most pharmacogenomic clinical decision support typically occurs in academic medical centers rather than community pharmacies. (JAPhA)
