Why we need a modern act to prevent harm from medications

There are more than 20,000 prescription medications on the market in the U.S., and more than 300,000 over-the-counter drugs available.

Twenty percent of adults in the U.S. are on five or more prescription medications, and half of adults report taking two or more prescription drugs. Many are also taking over-the-counter medications.

In total, a possible 6 billion drug combinations exist on the market.

It’s impossible for any healthcare clinician to master all the effects of those interactions. Making matters worse, they often don’t know what other medications patients have been prescribed and are therefore unaware of other possible interactions. Additionally, many people don’t report the use of over-the-counter products and dietary supplements to their doctors.

The result is that a countless number of people may be unknowingly harming themselves every day. Uncoordinated prescription regimens can lead to decreases in drug efficacy and greater risk of adverse effects, such as falls, emergency room visits, hospitalization, and even death.

It’s no surprise that adverse drug events (ADEs) in the U.S. are estimated to be the fourth leading cause of death. Drug interactions are tied to 1.3 million emergency department visits each year, and 350,000 annual hospitalizations, according to the CDC.

They are costly, as well. Research estimates the annual cost of ADEs is between $30 billion and $130 billion.

Combined with the phenomenon of medication overload, we spend more money to correct problems related to medication (an estimated $528 billion in 2016) than the amount we spend on the medications themselves ($329 billion in 2016).

There have been attempts to make a difference, but more needs to be done now. The U.S. needs to adopt new policies to reduce the toll of ADEs.

Most of those impacted by ADEs are older. The majority of Americans who take more than one prescribed drug per day are older adults and those with chronic diseases. Fatal adverse drug events are more likely to occur in people aged 55 or older and are most severe for people over 75.

To address the problem, the Center for Medicare and Medicaid Innovation (CMMI), which runs experimental model designs within the Medicare and Medicaid programs, launched a model in 2017, called Enhanced Medication Therapy Management (EMTM). It created financial incentives for private prescription drug plans — the entities administering Medicare’s drug program — to develop solutions to prevent ADEs. One of those solutions involved pharmacists and physicians working collaboratively to improve the coordination and assessment of all medications.

The results were significant.

A study published in 2021 evaluated the impact of pharmacist-delivered medication safety reviews (MSRs) on total medical expenditures, hospitalizations, emergency department visits, and mortality in Medicare Part D beneficiaries whose plan was a participant of the EMTM model. Those who received these holistic reviews demonstrated significant improvements in every metric compared with eligible beneficiaries who did not receive the EMTM services.

While the model ended in December 2021, it showed it was possible to reduce emergency department visits, improve patient quality of care and save lives, reducing net Medicare expenditures by addressing medication interactions prior to the development of ADEs.

These results are a clear call to action.

We need to address the issue with policy, and the EMTM model is an indicator of the success a modern act to optimize medication regimens can have. Legislation designed to provide major savings on healthcare costs in the Medicare and Medicaid programs and improve the quality of care by identifying multi-drug medication risk and reducing adverse drug effects would save lives the second it passed.

Doing this involves bringing resources together. Improving the safe use of medication requires computer-driven medication review to better inform where risk exists. Effective programs will need engagement and coordination between community pharmacists and prescribing clinicians in a systematic and organized manner, leveraging the things each does best to drive real results for people who need it.

Too often, the U.S. healthcare system appears to be a series of highly sophisticated but ultimately uncoordinated interventions, each focused on solving their own specific problem. People rarely get a holistic assessment of their prescribed treatments, how they may interact with one another, and what impacts they may collectively have. The consequences are lethal, and best represented by the adverse outcomes associated with drug interactions.

The safety of Americans and the long-term financial health of the Medicare and Medicaid programs depend on how we act right now.

Mark A. Munger, Pharm.D., F.C.C.P., F.A.C.C., F.H.F.S.A., is the professor, pharmacotherapy; adjunct professor, internal medicine (cardiology); and associate dean, college affairs (College of Pharmacy) at the University of Utah.

Jacques Turgeon, B.Pharm., Ph.D., is the chief scientific officer for Tabula Rasa HealthCare and professor emeritus at the Université de Montréal.

Wilson D. Pace, M.D., F.A.A.C.P. is the chief medical and technology officer for DARTNet Institute and professor emeritus, family medicine, at the University of Colorado.