Older Adults' Experiences with Comprehensive Medication Reviews

Older adults often have complex medication regimens with multiple prescription and non-prescription medications. Previous research has shown that medication-related challenges such as incorrect doses, drug interactions, side effects, poor adherence, and high costs are common among this group.

One way to maximize the benefits and minimize the harms of medications is through a Comprehensive Medication Review (CMR). A CMR is an in-person, telephone, or video appointment, often with a pharmacist and a patient or caregiver, at which medications are reviewed, including how they are taken, their indications, side effects, potential for interactions, and costs. In December 2019, the University of Michigan National Poll on Healthy Aging asked a national sample of older adults age 50–80 about their medication use and experiences having CMRs with pharmacists.


Medication use

Two in five adults age 50–80 (41%) take two to four prescription medications, and 23% take five or more. About half of older adults (52%) take two or more non-prescription medications, such as over-the-counter or herbal medications, or nutritional supplements. Of those taking five or more prescription medications, 32% reported also taking five or more non-prescription medications or supplements.

Adults age 65–80 were more likely than those age 50–64 to take five or more prescription medications (30% vs. 19%) and were also more likely to take five or more non-prescription medications (15% vs. 9%).


Comprehensive Medication Reviews

Among individuals who were taking two or more prescription medications, one in four (24%) had ever had a CMR. A similar proportion of older adults who were enrolled in Medicare Part D prescription drug plans—which cover CMRs for eligible members—reported ever having a CMR (25%). Of the older adults who ever had a CMR, three in four (75%) had one in the past year. 

Ever having had a CMR was more common among older adults taking five or more prescription medications (29%) than among those taking two to four prescription medications (21%).

Among adults 50–80 who had not had a CMR, the majority (86%) were unaware that their insurance might cover one, including 85% of those enrolled in a Medicare Part D prescription drug plan.

Two in five older adults who reported taking five or more prescription medications and having never had a CMR (43%) were interested in having a CMR in the future.


Implications

CMRs are an underutilized opportunity to help ensure medication regimens are as effective, safe, and affordable as possible. This poll found the majority of adults age 50-80 who take multiple medications have never had a CMR and were not aware that a CMR might be covered by their insurance.

Increasing awareness about coverage for CMRs among older adults, particularly those enrolled in Medicare Part D plans, is important. For 2020, the eligibility criteria for Medicare coverage for a CMR include having multiple chronic conditions, taking multiple medications, and having Part D annual medication costs of at least $4,255. Part D plans are rated on how many eligible members receive a CMR, creating incentives to increase awareness and use. Some non-Medicare insurance plans also cover CMRs for those who are eligible.

Older adults who are concerned about drug costs could benefit from a CMR. During their CMR, older adults can ask if there are lower cost medications that will achieve similar results, and if so, they or their pharmacist can talk with their health care providers about switching to a lower cost medication.
Another group that may benefit from a CMR is the sizeable percentage of older adults who use a combination of prescription and non-prescription medications. Non-prescription medications and supplements can cause harm when taken in the wrong dose or in combination with other medications.
Older adults should maintain their own updated medication list, tell their health care providers about all prescription and non-prescription medications and supplements they take, and inquire about getting a CMR by video, phone, or in-person to make the best use of their medications. 

Data Source and Methods

This National Poll on Healthy Aging report presents findings from a nationally representative household survey conducted exclusively by Ipsos Public Affairs, LLC (“Ipsos”) for the University of Michigan’s Institute for Healthcare Policy and Innovation. National Poll on Healthy Aging surveys are conducted by recruiting from Ipsos KnowledgePanel®, the largest national, probability-based panel in the U.S.

This survey module was administered online in December 2019 to a randomly selected, stratified group of older adults age 50–80 (n=2,048). The sample was subsequently weighted to reflect population figures from the U.S. Census Bureau.

The completion rate was 77% among panel members contacted to participate. The margin of error is ±1 to 2 percentage points for questions asked of the full sample and higher among subgroups.

Findings from the National Poll on Healthy Aging do not represent the opinions of the University of Michigan. The University of Michigan reserves all rights over this material.

Citation

Coe A, Malani P, Singer D, Solway E, Kirch M, Kullgren J, Farris K. Older Adults' Experiences with Comprehensive Medication Reviews. University of Michigan National Poll on Healthy Aging. October 2020. Available at: http://hdl.handle.net/2027.42/163318