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Partnerships with geriatric pharmacists will be critical for brand teams that market products specifically to seniors.
Senior-care specialists are quickly becoming a necessity rather than an option in today's rapidly changing healthcare environment. The US healthcare system is undergoing monumental change due to an increasing population of seniors and the introduction of Medicare Part D, the new prescription drug benefit that will be administered by Centers for Medicare and Medicaid (CMS) in 2006. These factors are placing the geriatric pharmacist in a position of paramount importance and will continue to do so in the future.
For years, we have seen demographic projections indicating that the senior population in the United States is not only growing at a dramatic rate, but is also living longer. According to the American Society of Consultant Pharmacists (ASCP), there are 38 million seniors in the United States. But by 2030, the ASCP projects that the number will rise to 75 million. Seniors are expected to continue to live longer. "If we can change the aging process—by eliminating aging-related diseases—in the next 10-20 years, the average life span could be in the 90s," says Donald Louria, MD, professor at the department of Preventive Medicine & Community Health, UMDNJ-New Jersey Medical School.
Despite their increasing longevity, very few senior patients have access to geriatric pharmacists or those who are most qualified to optimize their therapeutic outcomes. The creation of the Medicare Prescription Drug benefit will undoubtedly serve as a catalyst driving increased demand for specialists trained in handling the unique needs of geriatric patients. Many anticipate that it will also increase prescription drug utilization within the senior segment and spark an upward trend in the number of geriatric pharmacists. As a result, partnerships with geriatric pharmacists will be critical for brand teams that market products specifically to the senior population.
The medication needs of seniors are very different from those of other segments of the population. According to a study published in Health Affairs in 2001, more than 77 percent of seniors between the ages of 65 and 79 suffer from one or more chronic diseases. That number rises to 85 percent for those over the age of 80. "It is common for senior patients to be afflicted with multiple conditions such as coronary heart failure, hyperlipidemia, hypertension, and diabetes," says Mona Chitre, director of clinical services for FLRx and pharmacy benefits administrator for Excellus BlueCross BlueShield. Visual and/or cognitive impairment and decreased renal clearance are other conditions commonly found in seniors that can interfere with patients' ability to adhere to appropriate drug therapy regimens, and may contribute to drug overdoses and interactions.
Furthermore, "physiological changes place seniors at a greater risk of adverse reactions when taking some medications," says Tom Clark, director of policy for the ASCP. The metabolic rate changes, organ function declines, and sensitivity to some drugs can be altered. When these variables interact in an older patient, individualized drug therapy is often required.
With this in mind, it's not surprising that seniors represent a significant portion of prescription medication use. Statistics released by ASCP indicate that while the elderly account for approximately 13 percent of the population, they consume approximately 40 percent of the total number of prescription drugs.
As a result, the government is taking steps to build programs to counterbalance the excessive use of prescription drugs by seniors. The Medicare Modernization Act mandates the implementation of Medication Therapy Management (MTM) services or programs that optimize therapeutic outcomes for Medicare beneficiaries who receive medication for multiple chronic diseases. Specifically, the legislation requires that all prescription-drug plan sponsors and Medicare Advantage plans offer an MTM program to ensure that drugs are used to optimize therapeutic outcomes and reduce the risk of adverse drug reactions in high-risk patients.
Ultimately, MTM programs translate into better health outcomes, which can enable the senior population to live longer, healthier lives. "MMA will ultimately increase access to medications," says William Simonson, chairman of the Commission for Certification in Geriatric Pharmacy. "However, throwing a trillion dollars worth of medications at seniors may be doing them a tremendous disservice if the drug therapy is not properly monitored. The older population is extremely vulnerable to medication-related problems. If seniors gain access without proper education and controls, we could face an unimaginable epidemic of polypharmacy." Polypharmacy, or use of multiple medications, has the potential to induce drug interactions that adversely affect seniors.
The Elderly Consume More Medicine
Data show that the number of Medicare enrollees afflicted with multiple chronic conditions is extremely high. "When you look at an elderly patient's profile, they may be on 10 scripts per month for maintenance of chronic conditions," says Melinda Odom, senior clinical pharmacist with CarePlus Health Plans. In fact, the Academy of Managed Care Pharmacy states that approximately 80 percent of Medicare-eligible seniors have multiple chronic conditions and about 20 percent of Medicare beneficiaries have five or more chronic conditions. More than two-thirds of Medicare spending goes toward the latter population.
MTM programs are specifically designed to prevent these negative outcomes and keep seniors on track with their drug regimes. By calling for medication treatment plans, regular drug reviews, therapy-response monitoring, verbal education and training, and support services for patients, these programs can increase adherence and decrease adverse drug events among the Medicare population.
While many Medicare plans have not publicly announced the details of their MTM programs, pharmacists are expected to play a crucial role in their implementation. "With the new Medicare guidelines, there is a huge opportunity for geriatric pharmacists and the specialized expertise they bring to the table," says Chitre. She says there will be a push to work with pharmacists who have expertise in geriatrics to help create better health outcomes, maximize efficiencies in drug therapy, and identify cost-saving opportunities.
"I've seen so many situations where problems were caused by drug therapy," says Simonson. "So many times these negative outcomes were entirely preventable. By participating in the coordination of drug therapies of elderly patients, geriatric pharmacists play the role of risk managers—for both patients and physicians."
Certified Geriatric Pharmacists
In addition to MTM programs, CMS provides guidance to Medicare plans by providing geriatric-specific insight for the formulary design process. CMS mandates that Medicare plans have a P&T Committee including at least one practicing pharmacist or physician who specializes in care for the elderly or disabled. Specifically, P&T committees will now have to focus on products unique to the senior population, such as medications for Alzheimer's disease.
"The new Medicare prescription-drug benefit and medication-therapy management programs are a whole new frontier for pharmacists," says Chitre. "We need to be educated on how to treat patients, lower costs, and decrease side effects in the elderly population."
Pharma companies that specialize in marketing products to the senior population are starting to recognize senior-care specialists as an influential new group within the managed care arena. "We are monitoring trends in geriatric pharmacy and are looking to create early partnerships with organizations seeking to improve pharmacy care for the elderly," says Tom Koenig, senior director of segment marketing for Endo Pharmaceuticals.
Marketers can do this by providing educational tools on senior-focused disease states. "Tool kits and on-the-go presentations are two examples of initiatives that work well, benefiting both patients and healthcare professionals," says Carla Saxton, assistant director of policy and advocacy for ASCP. The tool kits, which often include brochures and booklets; CD-ROMs and videos; and Web sites that relate to the diagnosis, treatment, and management of high blood pressure, high cholesterol, diabetes, and other afflictions prevalent among the senior population, can play a valuable role in helping seniors as well as pharmacists obtain the information needed to optimize therapeutic outcomes.
By educating pharmacists and consumers, these resources will ultimately help increase patient adherence, reduce drug interactions, prevent costly hospitalizations, and boost the overall health of seniors. Revolutionary changes in Medicare and an aging American population are altering the US healthcare system in a big way—from the way it is structured, to the way formularies are developed, to the way healthcare services and products are delivered and reimbursed.
Advanced Practice Communications will represent Medquest Communications' Behavioral Health Management and ENT Journal. • Dorland Global Health Communications was selected as the agency of record by Baxter BioSciences for the launch of Gammagard Liquid intravenous immunoglobulin Chandler Chico Agency was made agency of record for the Global Alliance for TB Drug Development. • Dowpharma selected Mentus Life Science as its agency of record.
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Phil Patrick is president of PharmaStrat. He can be reached at firstname.lastname@example.org