Employers who have succeeded in getting their employees to manage a chronic
illness by taking necessary prescription medicine now face a new dilemma:
harmful drug cocktails consumed by patients who are treating several chronic
is set to announce today that it will study whether counseling with
pharmacists reduces the incidence of adverse reactions that occur when its
employees take multiple drugs for unrelated conditions. Such harmful effects
can occur between prescription drugs, over-the-counter medicines and dietary
and herbal supplements. The university is among a handful of employers trying
to learn how best to manage the use of multiple medications.
“We ought to have someone looking at the overall picture here to make
sure things work well,” says Leslie Shimp, the professor at the
who is leading the project.
Researchers at the pharmacy school will begin a pilot program next month to
provide counseling to 3,000 employees, dependents and retirees who regularly
take at least nine medications. The goal will be to see what kinds of
counseling best help individuals safely adhere to their drug regimens. Another
goal is to encourage people to use cheaper generic drugs.
Every day, 85 percent of adults take one or more prescription drugs,
over-the-counter medicines, herbal medications or supplements, while nearly
one-third of adults take five or more every day, according to the
Despite the prominent role medicine plays in people’s everyday lives,
patients are not necessarily using drugs correctly or with awareness of how
they interact with other medicines. The inappropriate use of medications leads
to more than 1.5 million serious medical events each year, all of which are
considered preventable, according to the
“We know that adverse reactions go up almost exponentially depending on
the number of drugs you take,” says Dale Christensen, a professor emeritus
Some disease management programs have focused on managing chronic illness,
like the program begun 10 years ago in the city of
, to manage diabetes.
But programs that look at the entirety of a person’s medical therapies
are more recent and less studied. Federal law governing Medicare Part D, the
prescription drug benefit that was introduced last year, mandates that
individuals with several chronic conditions who take multiple medicines
receive what is called “medical therapy management.” Since then, employer
groups have taken a closer look at better managing the regimens of employees
who have high health care costs associated with chronic illnesses.
“The way you get value for your dollar is to make sure that medical
therapies are used properly,” Christensen says. “If not, it’s waste of
money at the very least.”
The issue is one that affects more than just retired people. At the
, the patients in the pilot program, more than half of whom are 18 to 65 years
old, take an average of 12 medications daily, not including non-prescription
medications. The goal of the program is to improve the management of chronic
diseases, reduce side effects and harmful drug interactions, and simplify the
pill-taking process, Shimp says.
The university also expects to save money by moving people to generics,
eliminating redundant medications and avoiding medical errors that result in
expensive hospitalizations and lost productivity. Exact savings, however, have
not been adequately measured, according to the
In order for other employers to reproduce the program, they must contract
with local pharmacists who can provide a clinical setting where one-on-one
counseling can take place and persuade their population to use the counseling.
Other employers, like Pitney Bowes, are using on-site clinics or on-site
pharmacies managed by pharmacy benefit managers to provide similar counseling.
“I think that patients are often interested in talking to somebody about
their medicine,” Shimp says, “especially if they are taking a lot of
Management, March 21, 2007