May/June 2023

Medication Monitor: The Benefits of Medication at Home
By Lindsay Dymowski
Today’s Geriatric Medicine
Vol. 16 No. 3 P. 26

Medication-at-home models help patients age in place.

During the pandemic, the country hunkered down at home and made do with piecemeal approaches to getting the things they needed. The food delivery app industry thrived,1 schools figured out how to deliver education to kids, and the health care industry learned to fully embrace telemedicine and home delivery of medications.

Home delivery of medications is not a novel concept. There have been companies that specialize in home delivery operating since the 1980s. However, the pandemic brought increasing awareness of the efficiency and cost savings that can come with medication delivered to the home paired with tailored pharmacy services to support the chronically ill and aging in place.

There are many benefits to be found in the medication-at-home pharmacy model, particularly for patients who would otherwise be in a long term care (LTC) setting. This patient population has specific needs that can be well addressed by allowing them to stay in their homes as much as possible and striving to serve them as they age in place.

Accessibility
One of the most significant issues for many older adults is the lack of mobility that comes with age or medical issues. It’s estimated that up to 4 million adults2 in the United States are entirely homebound. They typically have one or more serious medical conditions and decreased mobility, and some even may have once been relegated to living in a nursing facility. However, the cost of such facilities—combined with a push in recent years to allow people to stay in their homes as long as possible—has made medication at home a welcomed and viable option for the chronically ill and those aging with accessibility concerns.

The medication-at-home model offers many options for those needing LTC and regular access to medications for chronic illnesses. When developing an at-home care plan, doctors, pharmacists, and caregivers should consider the ability of the patient and what support is needed by the pharmacy. The core of medication-at-home services includes customized compliance packaging, home delivery, and 24/7 access to a clinical pharmacist. Other services include in-home counseling, vaccinations, and over-the-counter products such as bed pads and toothpaste delivered directly to patients with their monthly medications.

Adherence
Since the advent of medication at home, numerous studies have demonstrated how these models improve adherence to medication directives and patient health overall. One study3 supports the patient delivery model, showing that patients could be 45% more likely to take their medications as prescribed if they are delivered to their homes. This increased adherence to a medical regimen can improve health outcomes overall, especially for people with chronic conditions such as diabetes and high blood pressure.

Nevertheless, many factors may stand in the way of medication adherence, such as a lack of skills available to comprehend instructions or poor social support. The medication-at-home pharmacy model is addressing several pain points that stand in the way of adherence—accessibility, organization of medications through compliance packaging, and patient support through pharmacy-based care teams.

Medication nonadherence can be a common issue plaguing providers seeking to improve patient outcomes. It is also costly, leading to hospital readmissions and an increased need for more medical interventions. One study showed an $8 million cost per 100,000 patients linked to medication nonadherence.3

In addition, there’s also a heavy health price to pay for the patient and their caregivers. When patients are non-adherent to a medication plan, their needs increase, and their future likelihood of aging in place at home is jeopardized.

The increased availability of medication at home, particularly through community pharmacies with clinical capabilities, has dramatically improved adherence and led to healthier patients overall as a result. Many at-home pharmacies also have built-in care teams that go beyond a “fill-and-bill” approach, monitoring patient adherence and outcomes and becoming an essential part of the patient’s care team.

Price Reduction
Overall, people are concerned about the rising cost of necessary drugs. Prescription medication costs have risen exponentially4 in the last decade, especially for specialty drugs. Several provisions within the Inflation Reduction Act cover drug pricing, allowing for price negotiation in Medicare Parts B and D for certain medications. While the average citizen waits for the results of these provisions, they will seek other ways of saving money on their needed medications.

Many people fail to fully adhere to their medication regimens due to cost. According to a 2021 Kaiser Family Foundation study,5 three in 10 adults say they ration or skip medication altogether due to high prescription costs. Older Americans receiving LTC at home are particularly vulnerable to a lack of prescription affordability. Millions of older Americans take multiple medications, lack prescription drug coverage, or have a fixed income that is so low that prescriptions are cost prohibitive.

Through the medication-at-home pharmacy model, people can take advantage of cost reductions only available to these types of providers. For those without insurance, prescription costs are typically lower at community pharmacies than they often are at brand-name pharmacies. For those with insurance, many private insurance companies—along with Medicare—are jumping on the medication-at-home bandwagon. When pharmacies adhere to specific criteria detailed in the Medicare Part D guidelines, they can offer prescriptions covered under the plan for their LTC-at-home patients. Some are advocating6 for better coverage for LTC needs in the home for Medicare patients. Still, the availability of covered prescriptions stands to change the game for patients looking to stay in their homes and manage their own medication needs.

Technology Aids Better Outcomes Overall
With ever-advancing improvements in technology come innovations that help people live longer, healthier lives. The surge in telehealth has allowed people to stay in their homes. In a recent national survey, older adults reported having broader access7 to the technology necessary for easier aging-in-place at home. The better we help prepare those we love and care for to age in place, the more confident the older generation will be about choosing that as a primary plan for their winter years.

Concerning pharmacies, technology has aided both provider and patient in accessing not only reduced-price prescriptions but overall medication management. EMRs allow providers to share information, manage prescriptions, and permit full-service online pharmacies to become an active part of the medical management team.

Issues such as forgotten refills, running out of refills, or running out of medication could all be a thing of the past with pharmacy management of prescription needs. This can be particularly useful for those taking many medications, older adults experiencing memory loss, or family caregivers juggling many aspects of their loved one’s care.

Technology also allows at-home pharmacies and other providers to track metrics. The data recovered can lead to improved technology in the near future and help providers tailor services like medication-at-home to the exact needs of their target population.

The Future of Aging in Place
Things are rapidly changing for the aging population. The concept of aging in place in the home has to go beyond simply employing visiting nurses and instead must strive to meet all of the needs of those who want to stay in their homes as long as possible. Aging in place is growing in popularity as known issues with LTC facilities—such as short staffing and quality problems—have prompted more people to choose at-home care for themselves or their loved ones.

LTC health costs are becoming astronomical, and many who are on the other side of 65 will seek a way to cut costs and pay better attention to their needs. Medicare does not yet provide an all-inclusive LTC option for aging Americans, so many are forced to cobble a plan.

The surge in popularity of medication-at-home pharmacies has helped uncover a great need for more innovation in the LTC space. The preferred medical model is shifting toward a more value-based focus that seeks to improve outcomes, strengthen the relationship between patient and doctor, and usher in a new era of better health for Americans overall.

— Lindsay Dymowski is president of Centennial Pharmacy Services, a leading medication-at-home pharmacy, and cofounder and principal of The Centennial Group, a pharmacy management company supporting community pharmacies and health systems. Combining more than 15 years of pharmacy experience with an entrepreneurial spirit, Dymowski knows exactly what drives successful pharmacies, launches collaborative provider programs, and gets the attention of payers. Passionate about the business of pharmacy and its future in health care, Dymowski has presented at national conferences, received media coverage throughout various outlets, designed continuing education curriculum, and currently sits on several boards committed to the advancement of the practice of pharmacy.

References
1. Wetzler T. Food delivery app boom continues following lockdown-driven growth. Adjust website. https://www.adjust.com/blog/food-delivery-apps-thrive-following-covid-growth/. Published November 2, 2021. Accessed November 17, 2022.

2. Weiner S. Homebound, but not homeless. Association of American Medical Colleges website. https://www.aamc.org/news-insights/homebound-not-hopeless. Published April 6, 2021. Accessed November 17, 2022.

3. Heath S. Home-delivery meds may be solution to medication non-adherence. Health IT Analytics website. https://healthitanalytics.com/news/home-delivery-meds-may-be-solution-to-medication-non-adherence. Updated February 26, 2016. Accessed November 17, 2022.

4. Parasrampuria S, Murphy S. Trends in prescription drug spending, 2016–2021. Assistant Secretary for Planning and Evaluation website. https://aspe.hhs.gov/reports/trends-prescription-drug-spending. Published September 30, 2022. Accessed November 17, 2022.

5. Hamel L, Lopes L, Kirzinger A, et al. Public opinion on prescription drugs and their prices. Kaiser Family Foundation website. https://www.kff.org/health-costs/poll-finding/public-opinion-on-prescription-drugs-and-their-prices/. Published October 20, 2022. Accessed November 17, 2022.

6. Medical at home. National Community Pharmacists Association website. https://ncpa.org/medical-home-mah. Updated January 2022. Accessed November 17, 2022.

7. Robinson-Lane S, Singer D, Kirch M, et al. Older adults’ preparedness to age in place. University of Michigan Institute for Healthcare Policy and Innovation website. https://www.healthyagingpoll.org/reports-more/report/older-adults-preparedness-age-place#:~:text=Home%20features,necessary%20features%20. Published April 13, 2022. Accessed November 17, 2022.