Over-the-counter (OTC) medications often seem harmless, given their easy accessibility and perceived safety. However, these drugs may unknowingly complicate medical conditions and interact with prescribed medications given to you by your healthcare provider, leading to increased healthcare costs for payers. Clinical pharmacists, with their expertise in medication management and drug-disease interactions, play a pivotal role in helping benefit navigators mitigate these risks and ensuring members receive the most effective and cost-efficient treatments.
The Hidden Costs of OTC Medications
Many of your members likely assume that if a medication is available over the counter, it is entirely safe and can be used without restrictions. Unfortunately, that’s not always the case. Common OTC drugs like ibuprofen or antacids can have significant side effects, especially for members with underlying health issues.
Ibuprofen Overload
Consider a member with pre-existing high blood pressure who starts taking ibuprofen to manage knee pain. They might believe that taking 800 milligrams of ibuprofen daily for a few weeks is safe. However, this can increase their blood pressure and may lead their doctor to add more medications to manage their blood pressure, rather than eliminating the initial culprit, ibuprofen. Additionally, high doses of ibuprofen long term can severely harm their kidneys, potentially leading to chronic kidney issues and even acute kidney failure.
Too Many Tums
Excessive consumption of calcium-based antacids like Tums can lead to calcium overload, causing kidney stones or acute kidney failure and hospitalization. Patients might not realize the risks associated with high calcium intake, emphasizing the need for professional guidance in medication management.
The Crucial Role of Clinical Pharmacists
Clinical pharmacists are essential in navigating complex medication management. They can review members’ full medication profiles, including prescriptions, OTC drugs and herbal supplements, to identify potential interactions and side effects. This comprehensive review helps prevent unnecessary healthcare costs and complications and ensures members receive the most effective treatments.
Identifying Red Flags
When a clinical pharmacist conducts a medication review, they can spot red flags that indicate underlying health issues:
- For example, if a patient frequently uses OTC pain relievers, it might signal chronic pain that requires a specialist’s attention.
- Similarly, regular use of gastrointestinal medications like Miralax or stool softeners could indicate conditions like irritable bowel syndrome, Crohn’s disease or ulcerative colitis.
- Proton pump inhibitors (PPIs) like omeprazole and esomeprazole, and H2 antagonists like famotidine, are frequently used for acid reflux. Overuse of these medications can lead to essential nutrient deficiencies.
By identifying these patterns, clinical pharmacists can guide benefit navigators to recommend appropriate treatment.
Managing Drug Interactions
OTC drugs and herbal supplements can interfere with prescription medications, reducing their effectiveness and prompting doctors to prescribe more expensive alternatives.
Herbal Supplements
OTC drugs and herbal supplements can interfere with prescription medications, reducing their effectiveness and prompting doctors to prescribe more expensive alternatives.
- Black cohosh, an herbal supplement commonly taken for menopause symptoms, can significantly impact the efficacy of statins, used to manage cholesterol. This interaction might lead physicians to prescribe newer, costlier drugs, dramatically increasing payer expenses.
- Ginseng can lower blood glucose levels, causing dangerous interactions for members on insulin.
- St. John’s Wort, another widely used supplement, can reduce the effectiveness of oral contraceptives, leading to unintended consequences.
These interactions highlight the importance of monitoring all medications, including supplements, to ensure patient safety and cost-effective treatment.
The Financial Implications for Payers
When OTC drugs interfere with prescribed treatments, the financial burden on payers can be substantial. Statins are a prime example. Patients over 65 often take statins to manage cholesterol. If an herbal supplement like black cohosh reduces a statin’s efficacy, the doctor may switch the member to a more expensive alternative. This switch from a first-line statin costing around $4 to advanced treatments like Repatha or Praluent, costing between $600 and $800, illustrates how interactions can lead to significant price increases. This significant price jump reflects the increased specificity and manufacturing costs of these newer drugs, leading to higher expenses for payers. Proper medication management and patient education can prevent these escalations and the associated costs.
Lowering Healthcare Costs
Clinical pharmacists work with benefit navigators to streamline medication regimens to be most effective for the member. By minimizing drug interactions and optimizing treatment plans, they reduce the need for hospitalizations and emergency visits. This proactive approach translates to significant cost savings for both payers and patients.
OTC medications, while convenient, can pose serious risks when not properly managed. Clinical pharmacists are vital in ensuring that these drugs do not undermine prescribed treatments or exacerbate underlying health conditions. By meticulously reviewing patients’ medication profiles and identifying potential issues, they help prevent unnecessary healthcare costs and improve patient outcomes. For payers, investing in benefit navigation with on-staff clinical pharmacists is essential for sustainable, cost-effective pharmacy benefits.
