Addressing adverse drug reactions and therapy duplication

A 59-year-old disabled female enrolled in Mosaic Pharmacy Service. This member has an extensive past medical history including chronic migraines, diabetes, high blood pressure, bipolar disorder, hoarding disorder, gastric ulcer, urinary incontinence, osteoarthritis, pulmonary embolism, and diabetic neuropathy.

The member was prescribed and taking 47 medications (both prescription and over the counter), and has 20 known drug allergies. During the home visit, the member reported having trouble remembering to take her medications, and also had trouble getting to the pharmacy to obtain refills.

During the subsequent medication review, a Mosaic clinical pharmacist identified the following issues with the member’s regimen:

• Duplication of therapy: the member is on 2 PPIs, 2 antihistamines, 2 calcium supplements, 2 sleep aids, 3 Vitamin B supplements, and 2 medications for overactive bladder
• Adverse medication event: severe constipation and hallucinations
• Drug-drug interaction: Btn insulin and a bp medication
• Medication requires additional monitoring: increased chance of bone fracture with PPIs, requiring a bone density test to check for osteoporosis

Following the clinical review, the following interventions were conducted to ensure the member is on the optimal medication regimen:

1. Initial recommendations were made and accepted to MD to de-prescribe due to duplication of therapy (ultimately de-prescribing 20 percent of the member’s medications)
2. Bone density test is to be scheduled
3. The member was enrolled in Mosaic’s medication synchronization program
4. Member was educated on how to monitor blood sugar, maintain a healthy diet, and tips to adhere to the medication regimen
5. A Mosaic home visit specialist revisited the member with takeaway bags to dispose of all expired or unnecessary medications, and to explain how to use the Mosaic medication box for her new medication regimen

In a one-week follow-up with the member, the patient reported to be doing very well on the new medication regimen. She has not experienced any hallucinations. She has agreed to work with Mosaic and her primary care provider to decrease the number of medications she is on. Mosaic will continue to work with both the member and provider to simplify her regimen. In total, savings to the patient amounted to $62.40 a year, and for the health plan totaled $1,276 a year.

In follow-up with the member’s primary care provider, he reported: “My experience with Mosaic Pharmacy has been very positive so far. Mosaic is easy to work with and I look forward to working with them again. My patient looked alert and is not slurring her words when I saw her today. She is very pleased Mosaic is involved.”