"Sarah," a patient with a history of heart failure, was reliably taking all the medications she was prescribed by her doctors and provided from her pharmacy. However, as Evolent Clinical Pharmacist Avani Arora performed Sarah's annual comprehensive medication review—a required element of all Medicare Part D plans—she realized something was amiss. Interviewing Sarah about her medication history, Avani learned that Sarah had previously taken an evidence-based ACE inhibitor proven to mitigate heart failure symptoms, decrease risk of hospitalizations and reduce mortality. Oddly, this drug had been left out of the presorted pill packs Sarah received from her pharmacy the two months preceding the medication review, and Avani worried that Sarah risked increased blood pressure or other complications without it.
"We place a lot of emphasis on adherence in our programs," explained Avani, who has helped lead Evolent's Medication Therapy Management program since 2015. "This patient was taking all of her pill packs on schedule, so that wasn't the issue. She just didn't realize that she was missing one very important medication."
Sarah could not recall whether her provider had advised she stop taking this medication, so Avani contacted the patient's cardiologist to dig a little deeper. After discussing Sarah's situation, the physician agreed that the therapy should be restarted and recommended immediate re-initiation of the heart failure medication.
A deeper dive revealed why the medication had gone missing: the prescription had been sent to a pharmacy Sarah no longer used, so it wasn't added to her pill packs. Once a new prescription order was sent to Sarah's new pharmacy, Sarah was successfully transitioned back onto an optimal heart health regimen. Avani later followed up with Sarah to ensure she had received the medication and advised her on the importance of the drug in helping to manage her cardiovascular health.
For Avani, this case reinforced the utility of annual pharmacist-led medication reviews. "Our outreach methods are designed to not give up on a patient after one attempt, and our persistence often pays off," Avani explained. "[Sarah's] case reinforces that our reviews can help surface even unintended gaps. Ultimately, it really validates our approach."
Associate Director of Clinical Pharmacy Services Lisa Sutton agrees. "It's important to note that our pharmacists have interventions with patients like [Sarah] every day," she says. "Avani did everything right with her, and it's a perfect example of how collaboration can work beautifully to improve long-term health care outcomes."