Polypharmacy Drug Regimen Modifications Lead to Cost Savings

The pharmacogenetic information that is currently available can significantly enhance the utility of prescription drugs and pro­vides an opportunity for improving patient care.

The US health care system spent approximately $300 billion dollars on prescription medications in 2014. Current estimates project that spending on prescription medications will increase incrementally by 6.3% per year over the next decade.

Polypharmacy (utlizing 5 or more prescription drugs per month) has become a huge problem, with approxi­mately 40% of the elderly and nearly 11% of the US popula­tion now taking 5 or more prescription drugs at any 1 time.

In a randomized control trial (RCT) published in Pharmacogenomics and Personalized Medicine (Saldivar et al. 2016:9:1-6), a pharmacogenetics (PGx)-assisted assessment was performed on 132 polypharmacy patients in a large managed care entity focused on improving patient care and reducing pharmaceutical costs in their long-term care settings.

The PGx was performed by a licensed PharmD using the IDgenetix (AltheaDx, San Diego, CA) product to assess opportunities to improve the medical management of these patients.

IDgenetix uses a proprietary algorithm to interpret genetic findings obtained from the analysis of patient DNA by obtaining a cheek swab to predict the most favorable drug response for that individual.

Interventions to Decrease the Cost of Prescription Drugs

The inter­ventions recommended via the IDgenetix tool and stan­dard methods were grouped into 3 basic categories:

1) A replacement of 1 medication for another deemed better suited to the patient’s genetic profile

• Medica­tions negatively impacted by certain genetic mutations were replaced with those metabolized via different pathways or those employing a mechanism of action in which all avail­able evidence indicated little or no effect from the genetic mutations identified.

2) Discontinuation of a medication that was determined to be ineffective

3) Consolidation of 2 medications into a single prescription

All 3 recom­mendations focused on maximizing the safety and efficacy profiles of each individual drug regimen evaluated with an emphasis on chronic medical conditions.

Results of PGx

The findings of this RCT mirror those that have been estimated by others in the field. Applying the IDgenetix-guided PharmD recommendations across this population would result in the elimination and/or replacement of 1 to 3 drugs in about 50% of the polypharmacy patient population tested.

Prescription Drugs Cost Savings Analysis

Using standard cost estimates, the recom­mended drug regimen modifications would lead to annualized savings of $81,972 for the study group, which equates to $621 in annual savings per patient across the entire popu­lation analyzed.

Psychotropic drug changes accounted for the largest savings by drug class, accounting for 61.3% of total savings. Neurology, cardiovascular, and urology medication changes accounted for 11.0%, 10.5%, and 8.1% of all savings respectively.

This approach increases the likelihood of reaching a therapeutic goal, improves patient adherence to therapy, and decreases the risk for an adverse drug reaction. These results lead to decreased health care costs, and provide opportunities to administer care in a safer, more efficient and cost-effective manner.