Almost one-third of U.S. counties have experienced an overall decline in local brick-and-mortar pharmacies—impacting medication access for over 91 million people and making it harder for them to adhere to the treatments they need to stay healthy.
Today, many are turning to mail order pharmacy services to get prescriptions amid drug store closures. But millions of people with chronic conditions and other complex medical needs require more than simply access to medications to avoid costly unplanned trips to the hospital and live more independently at home.
Managing chronic conditions is one of healthcare’s most pressing challenges. In 2023, 76.4% of U.S. adults—approximately 194 million people—reported managing at least one chronic condition, while 51.4% of U.S. adults—or 130 million people—reported at least two.
Medication is one of the first and most effective lines of defense when managing chronic conditions, serving as a tool to reduce and control symptoms, prevent complications and disease progression, and improve patient quality of life. But often, traditional pharmacy models are too transactional in nature to fully optimize chronic care outcomes.
It’s time to think differently about how we leverage pharmacy care to manage outcomes for people living with chronic conditions.
The Chronic Care Medication Challenge
People with chronic conditions face a variety of daily challenges managing their health—including complex daily medication routines. This can lead to a range of barriers that go beyond taking medications as prescribed to include potential issues with medication safety and clinical efficacy. If someone is adherent to the wrong medication or combination of drugs, it leaves them at risk for medication-related harm, potentially worsening health outcomes.
In fact, the more medication a person takes, the greater the risk of drug interactions. Research has shown a 50% chance of at least one drug interaction for people taking 5 to 9 medications. This risk increased to 81% for people taking 10 to 14 medications.
Fragmented care further adds to the complexity. Patients with chronic conditions frequently see multiple specialists who don’t often have full visibility into a patient’s complete medication profile. Without a holistic view, prescribers face challenges trying to prevent overprescribing or mitigating adverse drug events, which can result in falls or other health risks—and ultimately lead to avoidable ER visits and hospital stays.
With research demonstrating growth in the proportion of Medicare beneficiaries seeing at least 5 physicians annually, this is an increasingly prominent challenge.
When healthcare organizations and pharmacy care providers work together as part of an expanded, collaborative interdisciplinary team, it better supports patient success through transitions and across care settings—especially for those with complex care needs. A collaborative pharmacy care model should consider not only what a patient needs to be successful but also what providers need to better support their patients.
Comprehensive Pharmacy Care for Complex Needs
Medication adherence is essential for people managing multiple chronic conditions—it is critical to achieving optimal health outcomes and a foundational challenge in healthcare. As such, it’s a common focus for many pharmacies. But it is only one dimension of pharmacy care. Complex care also demands clinical oversight to ensure patients are taking the right combination of medications for optimal health outcomes.
“Medications don’t work if people don’t take them, and that’s why adherence is essential for optimal care—but adherence is not the finish line, and focusing solely on it risks missing the bigger picture,” said Brian Adams, President & CEO of AnewHealth. “For people with complex care needs, pharmacy can be a powerful lever to reduce risk, improve outcomes and personalize care. This requires a broader view that focuses on both improving adherence and optimizing medications for safety, effectiveness and better outcomes. Ongoing clinical oversight and proactive medication insights are key aspects of a strong pharmacy partner.”
A more comprehensive pharmacy model, designed to meet the challenges of complex care, empowers patients with a streamlined combination of tools to improve adherence while complementing prescriber efforts to proactively mitigate risk and optimize outcomes.
Tools like time-of-day packaging, national delivery and digital medication reminders at dosing times establish a strong foundation for adherence success and should be a minimum expectation of your pharmacy partner for people taking multiple medications.
Beyond adherence tools, addressing complex, chronic needs calls for ongoing clinical pharmacy support and oversight. Comprehensive pharmacy models should include a combination of the following to better support complex care needs:
- Prescription refill synchronization as a standard of care
- Pharmacist-led medication reconciliation with prescribers
- Proactive clinical pharmacist oversight, including monthly reviews for potential risks
- Clinical recommendations identified and communicated to prescribers
- Proactive refill coordination
More advanced complex care pharmacy models will be set apart by additional support to elevate patient and prescriber success:
- High-touch support to engage patients at the start of care and guide them through the pharmacy transition, including a thorough review of health and medications, for a more complete understanding of each patient’s situation
- More complete and accurate medication profiles built through one-on-one patient reviews and reconciliation with prescribers
- Advanced analysis to provide unique clinical insights for the most complex patients that focus on polypharmacy, going beyond the capabilities of existing tools that only identify one-to-one drug interactions
- Easy integration of actionable insights into existing workflows for electronic health records or clinical platforms to more proactively inform healthcare organizations how to mitigate and manage medication risks at the point of prescribing, before these risks escalate into bigger challenges
- Participation by the pharmacist as part of an expanded care team
Leveraging Pharmacy for Better Results
A more comprehensive pharmacy model provides an enhanced level of care to better manage complex needs—improving access, optimizing clinical effectiveness and helping patients consistently take the appropriate medications. This approach has been proven to keep patients healthier and reduce unnecessary healthcare utilization that can drive up costs for healthcare organizations.
A more comprehensive pharmacy model, provided by AnewHealth, has been proven to make it easier for patients to access, manage and take their medications. AnewHealth data show 94% adherence rates for diabetes, hypertension and cholesterol medications based on proportion of days covered. This exceeds the 80% threshold used by the Centers for Medicare & Medicaid Services in measuring adherence.
Research demonstrated at least one clinically actionable medication-related problem for over 80% of Medicare Part D beneficiaries included who received a pharmacist-led medication safety review. In stopping potential issues before they turn into bigger challenges, the result is safer, more effective medication therapy, including reduced ER visits (10.3%) and hospitalizations (10%).
By improving adherence and decreasing hospitalizations, comprehensive pharmacy helps boost key quality measures for healthcare organizations that ultimately impact revenue, including measures that affect Star Ratings, like HEDIS, and medical loss ratios. Notably, AnewHealth’s comprehensive pharmacy care model has been proven to reduce total cost of care by an average of $2,400 per patient per year, with savings increasing with patient complexity.
For healthcare organizations, it’s becoming increasingly important to help patients better manage their complex medical needs. Over the last two decades, the prevalence of chronic conditions has climbed steadily—a trend that is expected to continue. As chronic medical needs continue to rise, we must ensure we provide patients with the right level of pharmacy care to help them thrive.