Streamlining Prescription Processes

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: How can RazorMetrics’ solution help deliver better patient outcomes and substantial savings for healthcare plans, employers, and members alike?

Dorsett: The reality is, when you go to your physician, or just someone who would prescribe—a general nurse practitioner, what have you—they have very little visibility to what medications are costing you and your health plan, because they typically don't have access to the formulary. Even with the advent of what are known as real-time benefit tools, they're supposed to be used at the point of care to give you access to that information. The data flowing into those is very unreliable, because the PBMs that drive the information and the formularies don't really like playing in the same sandbox together. Half the time, you may make a call to one of those real-time benefit tool systems and it just comes up blank. There's no data, so you're going to stop using it pretty quickly, because you're having to go through all these extra clicks. So even though those are out there, the adoption has been fairly low and disappointing, even though they were also mandated in the 21^st Century Cures Act.

We, on the other hand, have a retrospective model that is going through claims data for prescriptions that have already been prescribed, and what we do is we put the information at physician’s fingertips basically in existing workflows, so they're not having to go outside of those. If they're having to take more time or go outside of their traditional workflows, or they've got the muscle memory, it's a non- starter. It simply doesn't work. That's what we became very good at over the years.

We're essentially getting a change order into the EHR. That's an official change order that also gives them some options. Optionality is important. Physicians don't always love being told what to do culturally. Basically, it's going through the prescription refill request queue, and they have to address those anyway. They just simply sign off on it, select a medication or decline it. What we do see is a response rate on those change orders of 74%—so we're getting them back most of the time—and an acceptance rate of 33%, so it's very effective.

They don't always accept it. Maybe the patient tried the medication in the past and it didn't work or created some other sort of issues, so they decline it. That's the critical importance of having the prescriber driving this process, not the patient having to go and advocate for themselves. Along the way, this polypharmacy issue started coming up, and we looked at it and realized, we can have an impact there as well, because we're already communicating with the physicians. The problem is, they don't have access to all the medications. If we could fix that, we could go a long way towards fixing this problem. Because we have all the claims coming in for all the medications that they're being prescribed, we have a holistic view of that information, so we're taking that out to the prescribers, so they can review the list and see if the patient shouldn't be on any particular medication, or if there's duplication. We've had a tremendous response from it. It's super effective for our clients. We've saved 10s of millions of dollars across the board with it. Then what we do is follow up after we see that medications have been de-prescribed and just confirm basically. Then typically, the prescriber will reach out to the patient and consult with them on it as well.