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Medication underdosing and underprescribing are often overlooked and can result in poor patient outcomes. They can also contribute to polypharmacy and significant cost to the healthcare system. Pharmacists can play a key role in preventing underdosing and underprescribing of medications by ensuring that patient-specific pharmacotherapy is prescribed and administered, and by providing patient and provider education regarding appropriate use of medications. While numerous examples of effective pharmacist-led interventions to reduce medication underdosing and underprescribing are described in the literature, further research is needed to elucidate new ways to improve patient outcomes and reduce unnecessary cost to the healthcare system. This article describes the clinical consequences of medication underdosing and underprescribing and provides examples of pharmacist-led interventions to address these medication issues.

Health insurers should use both medical and pharmacy data to forecast specialty drug costs, which are predicted to rise to 50% of commercially insured total drug costs by 2018, according to a new study presented at the Academy of Managed Care Pharmacy’s 25th Annual Meeting & Expo in San Diego, in April.

Biologic anti-inflammatory (BAI) specialty medications to treat autoimmune inflammatory conditions-such as rheumatoid arthritis (RA), psoriasis or inflammatory bowel disease (eg, Crohn’s disease, ulcerative colitis)-are among the most commonly used specialty drugs and costs are rising rapidly. Three new studies presented at the 2013 Academy of Managed Care Pharmacy’s 25th Annual Meeting & Expo in San Diego, in April, highlight the use, effectiveness and cost trends for BAIs.

Specialty drugs now account for half of the cost of treating patients with rheumatoid arthritis (RA) or hepatitis C (Hep C), according to 2 studies presented by St. Paul-based Prime Therapeutics (Prime) and Blue Cross and Blue Shield of Minnesota at the Academy of Managed Care Pharmacy’s 25th Annual Meeting & Expo in San Diego, in April.

Medication errors and adverse drug events (ADEs) pose large threats to patient wellbeing and safety. Medication errors are the most common errors occurring in hospitals. Preventable ADEs are linked with 1 in 5 injuries or deaths. Medication errors occur at key points of transition during the hospital stay. 4-6 At one institution, failure to reconcile medications at transition points accounted for 50% of all medication errors and 20% of ADEs. Medication errors and ADEs are harmful, but also costly to the patient and the healthcare system.7 Complete and accurate medication reconciliation is crucial for reducing medication errors and ADEs

Implementation of a pharmacy service that provides dosing, monitoring, education, and ensured safe transition from the inpatient to the outpatient setting is associated with improved patient satisfaction with overall care and with care related to anticoagulation management, according to a study published in the Annals of Pharmacotherapy.

Although the prevalence of diabetes mellitus in hospitalized patients remains unknown, an estimated one-fourth of inpatients experience hyperglycemia.1 Hyperglycemia is linked to poor health outcomes, and there is evidence that intensive glucose control in the hospital reduces mortality, need for dialysis, infections, and length of stay.2 The American Diabetes Association (ADA) publishes clinical practice guidelines annually, which offer clinicians, patients, researchers, and payers current, evidence-based recommendations on all components of diabetes care, general treatment goals, and tools to evaluate the quality of care. The updated guidelines focus on changes in the recommendations for care of the hospitalized diabetes patient.

The appropriate use of specialty drugs is a major priority for health plans and will become increasingly important for future growth over the next 3 to 5 years, according to a comprehensive survey on payer approaches to specialty drugs. Furthermore, the research finds significant variation in what health plans view as emerging areas of opportunity to manage these drugs.

Total spending on medicines declined by 3.5 percent, according to the IMS Institute for Healthcare Informatics report, Declining Medicine Use and Costs: For Better or Worse?” report. In addition, nominal pharmaceutical spending reached $325 billion in 2012, or real per capita spending of $898, a decline of one percent.

Women taking fourth-generation oral contraceptives, which use a progestin that is antiandrogenic, are at increased heart risk. The drugs significantly lengthen the corrected QT (QTc) by 3.6 milliseconds, according to a recent study in the Annals of Noninvasive Electrocardiology.

Teenagers who received DTaP (acellular pertussis vaccine) in their first 2 years of life had a 6 times higher risk of contracting pertussis compared with those who received DTwP (whole-cell pertussis vaccine) in their first 2 years of life, according to a study online in Pediatrics.

Older patients with chronic obstructive pulmonary disease (COPD) may be at increased risk for cardiovascular events with newly prescribed long-acting beta-agonists (LABAs) and long-acting anticholinergics (LAAs) and need to be followed closely by their healthcare providers, according to a study published online May 20 for JAMA Internal Medicine.

Obesity is a growing problem in the United States. Currently, 68% of adult Americans are overweight (BMI >25 kg/m2).1 Of those, 35% are obese (BMI >30 kg/m2) and 6% are morbidly obese (BMI >40 kg/m2). It is estimated that by 2030, 51% of the population will be obese and 11% will be morbidly obese.1 We are often confronted with dosing drugs in an obese patient. Unfortunately, many clinical trials exclude or have limited overweight patients enrolled; thus, optimal dosing for both safety and efficacy in this population is lacking. Pharmacokinetic studies in obese patients have shown that the volumes of distribution of lipophilic drugs and the clearance of hydrophilic drugs can be increased. For this reason, dosing in obesity should be patient- and drug-specific.

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