Simplifying Medication Regimen By Deprescribing

Background

An individual was referred to Mosaic Pharmacy Service to manage her regimen of 12 medications and multiple chronic conditions. The member is a 76-year-old female on 12 medications; medical history includes diabetes, hypertension, and depression. She is on five medications for diabetes and does not follow a diabetic diet or check blood sugar readings at home, indicating that she "can’t be bothered.”

Following a comprehensive medication review, a Mosaic clinical pharmacist identified the following challenges to the existing medication regimen:

• Complicated diabetic regimen: member does not monitor blood sugar and is on five medications for diabetes, increasing risk of hypoglycemia
• Cost: Januvia not covered by the insurance plan; member was paying $80/month
• Drug-drug interaction: increased risk of hypoglycemia with concurrent use of fibrates and glipizide
• Adherence: non-adherent to diabetic regimen, not monitoring blood sugar, and not on a diabetic diet

Interventions

As a result of the findings during Mosaic's clinical review, the following interventions were made:

• Recommendations were made to the member's PCP to simplify the member's diabetic regimen, including:
  • Discontinuing Januvia (not covered by insurance)
  • Increasing metformin dose if needed after checking A1C and renal function
  • Increasing Toujeo dose

• A recommendation was made to the PCP to discontinue fibrate if TRG<500 and to increase statin to a moderate-intensity dose
• A Mosaic clinical pharmacist educated the member on why and how often to monitor blood sugar, and how to maintain a proper diabetic diet
• The member was started on the Mosaic medication box

Outcomes

Following communication of the interventions, the member's PCP accepted recommendations to simplify the diabetic regimen by discontinuing two medications, discontinued the member's fibrate prescription, and increased the member's statin to a high-intensity dose.

Following discussion with the Mosaic clinical pharmacist, the member has begun monitoring blood sugar twice a day and eating smaller, heathier meals consistently throughout the day.

Through these interventions, the member and health plan have experienced the following cost savings:

• Member: $100/month (in co-pay and cash price for one diabetic med)
• Health Plan: $517/month