Avoiding Medication-Related Problems

Background

An 83-year-old female was referred to Mosaic to reduce the side effects of her current medication regimen and improve her adherence to treatment. The member’s medical history includes diabetes, hypertension, hyperlipidemia, hepatitis C, hepatic neurology, and gout. In total, the member was taking 16 prescribed and over-the-counter medications for these conditions.

Therapy problems that were identified during the virtual home visit included: hypoglycemia, with morning blood sugars running under 80; insomnia; and adverse drug reactions including swelling feet and increased falls due to a high dose of Gabapentin.

In addition, the member’s current pharmacy took 4 weeks to get prior authorization for Harvoni, which resulted in a therapy gap and cost the health plan $33,000 due to the lapse in therapy. Lastly, Mosaic’s Therapeutic Decision Support revealed the member was not adherent to her Jardiance  (diabetes) medication.

Interventions

Following the clinical review, a Mosaic pharmacist coordinated with the member’s providers to achieve an optimal blood sugar regimen, reduce the member’s fall risk, and lower the chance of a lapse in therapy with the member’s hepatitis C medication (Harvoni).  The following interventions were conducted:

• The Mosaic pharmacist talked with the member’s primary care provider; following discussion, the PCP agreed with recommendations to discontinue Glipizide due to hypoglycemia, decrease Gabapentin due to falls, add melatonin for insomnia, and schedule a shingles vaccination.
• The Mosaic pharmacist provided member education on a diabetic diet and the importance of staying adherent to all medications.
• The member’s PCP sent a new Harvoni prescription to the retail pharmacy to cover the patient an additional month; a Mosaic pharmacist called the retail pharmacy to ensure the prescription was filled on time and called the member for pickup.
• The member was started on Mosaic packaging to improve safety and adherence.

Outcomes

Provider communication and recommendations made to change patient’s medication regimen resulted in improved blood sugar levels and increased adherence. Outcomes include the following:

• Blood sugar readings stabilized after discontinuing Glipizide.
• Member experienced fewer falls after Gabapentin dose was changed to as-needed.
• The member is sleeping better at night after starting melatonin.
• Harvoni prescription was filled for an additional month and member is consistently picking up medication.
• Member is now adherent to all medications.

Feedback from the member’s provider:

“Where have you been? These pharmacies don’t understand the importance of getting medications to a patient on time.”