A Side Effect Cascade

In a video interview with Pharma Commerce, Tom Dorsett, CEO, RazorMetrics, describes how polypharmacy refers to the use of five or more medications by an individual, and it is becoming an increasingly prominent issue in the United States. Polypharmacy has been recognized for years but is growing more significant, especially within Medicaid, Medicare, and large commercial sectors, including self-funded employers.

One of the key drivers of this rise is the growing number of chronic conditions, which affect a large portion of the adult population. Around 40% of adults in the US have four or more chronic diseases, contributing to the increase in polypharmacy. Furthermore, among the working adult population between 40 and 79 years old, 24% are impacted by polypharmacy, a trend that continues to grow. This issue highlights the complexity and challenges of managing multiple health conditions and medications in an aging population, leading to potential risks related to drug interactions and overall healthcare management.

Dorsett also explains why he believes this concept is such an overlooked driver of unnecessary spending and adverse health outcomes, strategies that should be taken to overcome health information exchange blockages, and much more.

A transcript of his conversation with PC can be found below.

PC: Why do you believe polypharmacy is such an overlooked driver of unnecessary spending and adverse health outcomes?

Dorsett: It's a significant problem because it creates several different scenarios. One of the biggest is a cascade of side effects. When you think about it, you're getting prescribed medications for each one of these chronic diseases, and if the physicians aren't necessarily following what's known as the Beers List [Criteria], which is a list of drugs that have well known, acknowledged drug-to-drug interactions, then you're going to end up with this cascade.

Basically, you start getting side effects from the adverse reactions between the drugs, and you prescribe a drug for the side effect, which creates more side effects and so on, thus creating that cascade. The more drugs, the more cost. These adverse events also drive up emergency room visits. They're a very significant driver of increased emergency room visits, which are typically the most expensive medical encounters that you can have that aren't in-patient. It’s highly problematic in those regards, plus, it just has patients feeling worse because of the events that take place—because of the interactions—so the healthier you can get the population, the less this happens, and the less chronic disease there is.

We're starting to also see this with the advent of GLP-1s. Dropping weight creates a domino effect with hypertension, diabetes, and any number of different chronic diseases. There's a whole lot of promise with newer indications of GLP-1s coming out in the future. As you've probably seen, they're popping up all the time, regarding new and different ways that GLP-1s can help, so that's exciting. That's some something we're seeing, but nevertheless, we're still seeing growth in polypharmacy generally.