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Independent Insights, a Health Mart Podcast
Deprescribing Principles for Pharmacists
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Deprescribing is an important component of patient care as medication regimens are reassessed to ensure ongoing appropriateness, safety, and alignment with patient goals. This course reviews key deprescribing principles, including when it may be appropriate to discontinue therapy and important considerations for patient monitoring and follow-up. You will be better prepared to support evidence-based deprescribing decisions and collaborate with patients and providers to optimize medication use.
HOST
Rachel Maynard, PharmD
GameChangers Podcast Host and Lead, Clinical & Partnership Education, CEimpact
GUEST
Kristin S. Meyer, PharmD, BCGP, FASCP
Professor of Pharmacy Practice,
Drake University College of Pharmacy and Health Sciences
Pharmacists, REDEEM YOUR CPE HERE!
CPE is available to Health Mart franchise members only
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PRACTICE RESOURCE
Receive the exclusive Practice Resource to use as a reference guide for this episode by enrolling in the course. Click here to enroll!
CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Discuss key principles and clinical considerations for deprescribing.
2. Compare patient-specific factors that influence evidence-based deprescribing decisions, including risks, benefits, and treatment goals.
Rachel Maynard and Kristin Meyer have no relevant financial relationships to disclose.
0.075 CEU/0.75 Hr
UAN: 0107-0000-26-249-H01-P
Initial release date: 7/6/2026
Expiration date: 7/6/2029
Additional CPE details can be found here.
Welcome And Why Deprescribing Matters
SPEAKER_00Hi HealthMart Pharmacist, from your education partner CE Impact, this is Game Changers. I'm your host, Jen Moulton. And each week we have a conversation on a hot clinical topic that will keep you current in practice and position you as a resource for prescribers and patients. Thanks for listening in.
SPEAKER_01Today we'll be talking about de-prescribing. It's become an even more important part of medication management as patients live longer, regimens become more complex, and healthcare teams focus on reducing unnecessary medication burden. It's also become a part of a broader national conversation with recent discussions around psychiatric medication use, medication safety in older adults, and reimbursement for de-prescribing services. So today we'll discuss key considerations with de-prescribing and how we as pharmacists can help ensure de-prescribing decisions are both evidence-based and patient-centered. And I'm very excited to welcome our guest for this topic, who's an expert in this area, Dr. Kristen Meyer. So welcome, Kristen.
SPEAKER_02Thank you.
SPEAKER_01All right. Well, to help our listeners learn a little bit about you, if you wouldn't mind sharing a little bit about your background, your current role, and why you're passionate about this topic.
SPEAKER_02Sure. I have been a pharmacist over 25 years. It's hard to think about. I specialize in geriatrics. Deprescribing is a passion of mine. I think that the most important thing I do every day is help figure out what we can get rid of in those drug regimens of seniors that are experiencing polypharmacy. I teach at Drake University's College of Pharmacy and Health Sciences, and I practice with the good folks at Wright Dose Guardian Pharmacy in Anckney, Iowa.
SPEAKER_01Excellent. So it sounds like you have sort of that academic lens, but also the practical lens to bring to this discussion, which is excellent, sort of tying it all together.
What Deprescribing Really Means
SPEAKER_01So I think to kick things off, let's just start off with what deprescribing is. You alluded to it in your background there, but uh just to make sure we're on the same page, how would you define de-prescribing and clarifying what that actually means?
SPEAKER_02Right. So the essence of the definition of de-prescribing is withdrawal of inappropriate medications, or sometimes we say potentially inappropriate medications. It's supervised by a healthcare professional. It needs to include shared decision making. And the goal really is managing polypharmacy or reducing polypharmacy and improving outcomes for patients, whether that be decreased hospitalizations, decreased mortality, decreased cost, whatever the goals may be, increased quality of life. But yeah, it's just the peeling away of unnecessary medications. But it needs to be a methodical process.
SPEAKER_01Absolutely. So you highlighted a few important points there at methodical, patient-centered, but also making sure that we are considering the outcomes that what the patient's going to benefit from, and not just peeling away for the sake of peeling away, but really reevaluating and what's what's important to that patient from quality of life. Hospitalizations, as you said, outcomes. So that's a good clarification. And I love the phrase peeling away. I've also heard the term whittling. So, you know, some of these like sort of catchphrases that you can use to be thinking about it, uh, but really just ensuring that it's not something patients are doing on their own. It's something that is in concert with the healthcare provider. Right. Yeah. It it really needs to be, I mean, to be optimal and an interdisciplinary process. Absolutely. Okay. And why do you think it's gotten so much attention in the last few decades and also more recently? Why, why is it something that has sort of bubbled up to the conversations around patient care lately?
Why Attention Is Surging Now
SPEAKER_02Sure. Well, this idea of deprescribing is or medication optimization, some people like to say, has really just exploded over the last decade. You know, there were a few articles coming out, you know, um, in the say around 2015 or so. And since then, um, I would say that there are probably dozens of articles published every month on the topic. It's gotten recent um um a spotlight from our federal government. UmIG released a pretty scathing report again uh on the long-term care industry and over-prescribing of psychotropic medications uh this spring. But a little more on the positive side, DMS has kind of shined a light on this and really greenlighted pharmacists as being part of the solution to the problem and highlighted um the opportunities. I think as pharmacists, we we are well equipped to step into this role. But I think the idea of how do we operationalize that and how do we bill for it, I think that has been something we've been tiptoeing around. But um some recent guidance from CMS, I feel like has really greenlighted pharmacy to start thinking about ways that we can serve patients who need this service, um, education, and also like prescribing plans and billing for it in the incident two space.
SPEAKER_01So you highlighted that you know, this focus on deprescribing it has been going on more broadly, uh, and in terms of optimizing patient care and re-evaluating medication regimens, especially in the context of polypharmacy. That's sort of been this trend, as you say, for over a decade or so. And then more recently, you highlighted that what we may have been hearing about is um the report that suggests that antipsychotics specifically, I think, in the long-term care setting are potentially being prescribed or documented for indications when they may not exist. Is that sort of the the two-cent version of the summary there?
SPEAKER_02Yeah, yeah. I'd say as a drug class, antipsychotics have gotten the most attention. And and it's this it's this really difficult to care for population of patients with dementia who are experiencing behavioral symptoms. And it's important to keep these people safe and those around them, the caregivers, safe. And so sometimes we're employing medications such as antipsychotics for the safety of all, and that can be appropriate, but patients don't always need what they needed in the past. You know, we think about uh changes of aging and dementia is a you know a declining neurogenerative condition. So those situations, and not only antipsychotics, but kind of all psychotropics, warrant um continued monitoring and at least annual evaluation, if not my best practice is every six months, taking a look at those and making sure that all the reasons why we, you know, why that medication was started in the first place maybe still exist. And if some of those things don't exist, then that's where you have an opportunity to, you know, gradually reduce the dose and you know, thereby reducing side effects and adverse you know outcomes.
SPEAKER_01I think the key part there is that ongoing follow-up, not a set it and forget it type of approach, especially in our older population, ensuring that we are continuing to do that follow-up. If we focus in on that example of antipsychotics in dementia specifically, which is what has gotten some attention, that is such a challenging area of care. And I think, as you say, people are often stuck between a rock and a hard place and trying to figure out what we can do to ensure those patients are safe and that uh they're you know, not a threat to themselves or others. So, what how how do you approach a patient like that who maybe has been on an antipsychotic before, even for some time, and reevaluating that? Because I think that's sort of as the crux of this de-prescribing concept in general. And if we look at that specific example, how do you approach that patient?
Antipsychotics In Dementia Revisited
SPEAKER_02Yeah, so um, I think about it two different ways. Um, number one, I'll focus on the patient themselves or you know, or even their caregiver. Maybe they're not in a facility situation, but it's a family caregiver. So, you know, gathering information, finding out what the what the goals are for that patient or that caregiver, what are the symptoms that are being experienced, how severe, how frequent. So getting information on that side, providing education and reassurance. And we'll talk about some side effects and how to overcome some of the barriers with patients and caregivers and deprescribing. And then the other element is the interdisciplinary team. The best approach to dealing with patients with some, you know, psychiatric um symptoms is non-farm approaches. But we've got to be creative. It takes a whole team, and everybody's got to be on board that that's the goal. We're going to use medications as a last resort. But I, as the pharmacist, so I play my role. I'm trained in all the bad things that can happen with medications. And so, and so that's my role, and that's where I come in, and that's my hesitation to use or you know, medications and try to avoid this over-medicalization. Um, but I also need direct caregivers, nurses, therapists, whatever, to come in with those creative solutions to provide some non-farm approaches, to redirect, to keep busy, things like that. So we're avoiding um over-medicating.
SPEAKER_01And I I think you you alluded to a few of those non-pharmacological measures, and there are so many. It's so it's it can seem like, oh, you know, how will that really work? But there there are a number of different non-pharmacologic approaches that can be tried and uh together sequentially, sometimes it may work, sometimes it may not, but there there is a lot of support, and I think it is sometimes, as you said, being creative and working with the full care team in their options and solutions and seeing what's worked in the past and what hasn't. Um, but I think being persistent is probably a an important factor.
SPEAKER_02Yeah. Shout out to my colleagues in occupational therapy, real miracle workers. I think in this arena, I look
Non-Drug Strategies And Teamwork
SPEAKER_02to them for creative ideas on keeping people um, you know, physically active and and and keeping their minds busy as well.
SPEAKER_01Mm-hmm. Mm-hmm. And so in terms of that care collaboration, I think that's such an important component. And we have pharmacists listening in all different practice settings. And what best practices do you have in terms of that collaboration and and depending on how embedded you are with other clinicians, how do you how do you support those conversations and what can we be thinking about to promote effective collaboration? Right.
SPEAKER_02Communication is is paramount. Communication with patients, but also with with the other teams, so that we're all are in agreement on what the goal is. I'm not making recommendations to, you know, decrease the dose of this medication because, you know, well, we'll avoid all the reasons that you know a prescriber might think I'm making these recommendations, but we're all there for the betterment of the patient. If we focus on that patient, I think that most times we can agree. You know, if if if I'm seeing Mr. Smith falling asleep at the lunch table because Mr. Smith is taking a number of sedating medications, then that's going to be my main focus. And I'm going to communicate that. And I'm going to give a couple of ideas for how we might uh, you know, decrease medications to improve his wakefulness so that he can have proper nutrition. So, number one, communicating, keeping the patient at the center. And then when I'm proposing deprescribing plans, and there's lots of information and resources in the literature about how to go about this. Really, you know, it's an old mantra of geriatrics, start low and go slow. Well, deprescribing can be approached in that way in just the reverse. We don't, I never want to make more than one change at a time. We want to approach, you know, uh dosage reduction very um very gradually. So, what is the smallest change that I can make? If, you know, if they are taking a tablet, can I cut that tablet in half? You know, can then I maybe do it every other day? And providing reassurance. So communicating the plan, having a having a plan, communicating the plan, providing close monitoring and reassurance that there is a plan. We're not just getting rid of medications for the sake of getting rid of medications, but we have a plan, and the plan really focuses on safety. I usually will approach a patient or a provider with, I'm concerned about, you know, Mrs. Jones's increased falls. Here's two or three medications that increase her risk for falls, and here's some ideas for how they might be reduced to improve her safety. And then I think a lot of deprescribing plans fall apart when there is, and I've been guilty of this more times than I care to admit, when there's not adequate follow-up and monitoring. So what are the goals? What when do you check in? What kinds of things are you looking for? What what determines success? And it may, you know, it doesn't necessarily mean um need to be getting rid of the medication, but if we met the goal of decreased falls, increased wakefulness, that's a win. So yeah, I think communication and follow-up are just key.
Building Safe Tapers And Follow-Up
SPEAKER_01Yeah, and I love what you highlighted uh around keeping the patient at the center and having that guide your plan. And the two examples you gave, uh, the person who is drowsy, so drowsy, uh, it's affecting quality of life, the difficult, you know, difficulty getting adequate nutrition. And then the other example with falls, those are two very prime examples I think that probably come up all the time in your practice. Or you can frame it. I bet. And you can frame it from the perspective of keeping that patient's outcomes and well-being in mind and the safety aspect of it. So it's not, as you say, it's not taking away for the sake of taking away. It's because we are concerned about some adverse effect that that medication might be having.
unknownRight.
SPEAKER_01Yeah. And and then as you say, communicating that plan, ensuring everyone's on the same page, what the goals of the plan are, so that when you do have that follow-up, you're checking to see if those goals are being met and that there is a positive outcome happening. And then also, I loved what you said about the start low, go slow, the opposite of that. So I don't know what that would be. Go slow when stopping, sort of. You know, the opposite. But yes, a good concept there to be thinking about. And since we're talking about communication, that was really more on the provider side, but what about on the patient side and how you communicate that with the patient, especially considering that the patient is at the center of what we're trying to accomplish here?
Patient Goals And Shared Decisions
SPEAKER_02Right. Thinking about patients and families. Um, I want to mention the four M's. We can't talk about older people without talking about, you know, age-friendly care. So focusing on those four M's, medications, mentation, mobility, but first and foremost, what matters most, right? So that's how I communicate with patients and caregivers. I often will tell my students, like, you think you know what the problem is until you talk to the patient. And whatever the patient tells you is the biggest problem is the biggest problem today. Absolutely. So, you know, so I'll go into a conversation having reviewed a medication profile, but that's just one aspect. Right. You know, and then you talk to the patient and you're like, okay, well, we're gonna pivot and we're gonna focus on this thing. So what matters most is is what matters most. And then I think secondly, just providing that communication, that reassurance, I'm here to help you. My sole existence in this practice is to come in here and look at your medications. I'm trained to know what they do and all the bad things that can happen with them. And here's my concerns. And if you're also concerned about these things, I've got some ideas for how we can do better. I do a lot of talking about another passion of mine is fall prevention. So in the fall, in September, I try to schedule a lot of talks with senior living communities and talk about fall prevention, especially medications that contribute to falls. And I'm always pleasantly surprised at the number of people who come up to me afterwards. These are like assisted living, independent living senior communities, and they'll say, Oh, I take one of those medications that you talked about. Like maybe, maybe I should think about reducing that. And I'm like, that is a great idea. So patients are more willing, you know, if they just have that education, whether it's, you know, face-to-face, um, there was a pharmacy study many years ago now, but they were pretty successful with a deprescribing intervention with um benzodiazepines just by putting flyers in the bags of patients at pickup. And once patients were educated on some of the maybe pitfalls, no pun intended, of those medications, they were more willing to reduce and uh and eliminate those medications from their regimen. So that education is really important, but just reassurance that I'm I'm here to help you. You know, I that's the only reason why I exist, is so that you can feel better and do better.
SPEAKER_01And that goes back to your point: what matters to the patient is what we're focused on. So even though you may do your med review and have things in mind, we always need to prioritize what those patients' considerations are. And as you say, also increasing awareness. I love the idea of going to these facilities in the fall for fall prevention. It's a very I hadn't made that connection. So that's a nice little pun, uh, thinking about fall prevention going in the fall, September. Um, but yes, the idea that uh educating patients about the potential risks, even if they may not have those risks or considerations today, things could change in the future. And so be aware of that as something to watch for and report to your provider.
SPEAKER_02Right. Another story I like to tell is the gentleman who was taking an overactive bladder medication, highly anticholinergic one. And I shared with him my concerns about he had some mild cognitive impairment, and I shared with him my concerns about that maybe worsening his cognitive impairment. And he says, I don't care. That's the risk I assume. I had an accident at Walmart once. I don't ever want that to happen again. So I take this medication, it helps me. Yeah, so be it. And so I was like, fair, you know. So yeah, we really have to include the, you know, the decision making has to be shared decision making. It has to be patient-centered, or else the plans will um not be successful.
SPEAKER_01Absolutely. So that's a great discussion around the communication side of things. And I think we've got some really nice practical tips there from your experience.
High-Impact Targets Beyond Psychotropics
SPEAKER_01Thinking about you, so you mentioned um benzodiazepines, uh, the anticholinergia broadly, the anti, you know, the overactive bladder meds, but within anticholinergics. And then we talked about antipsychotics a little bit. Are there any other sort of high impact medication classes or or even specific medications that you're looking at when you're reviewing those meds and wanting to target potentially?
SPEAKER_02Yeah. So uh, you know, umbrella term psychotropic medications. Now, CMS looks at that as antipsychotics, antidepressants, anziolytics, incedative hypnotics. I've said before there is no safe sleep medication for older adults. So that's a biggie. Then branching out from that, anything that is used in that manner. So, you know, think about antiepileptics for mood stabilization, uh, antihistamines for anxiety, so and sleep. And so think about any sedating medication, any anticholinergic medication, if it has anticholinergic side effects, and then branching out from that medications that caught can contribute to falls, whether that be because they lower blood pressure, lower blood sugar, cause dizziness. So you can put a lot of antidepressants and anziolytics in that category as well. And then some other things that you may not always think about that are really good targets because of their long-term effects. So PPIs, that's another one that I really like to target. People get on PPIs and they just sit on there forever. They're hard to get rid of. Uh, the rebound effects are significant, can be. So then again, it's that low, slow process in reverse. But really, it's just scrutinizing every medication in the regimen and thinking about do we still need this? As people age, they will have decreased appetite, they will lose weight, they may not need the diabetes medications at the same levels as they did anymore. Hypoglycemia becomes a greater risk than hyperglycemia, to be honest. So I look at okay, do we need to lower those medications? Do we need to lower blood pressure medications? And then we, you know, we've talked about patients with dementia, but as he You know, as we go towards the end of life, what are the goals for this patient today? Do they need things like bisphosphanates? Do they need other medications like statins that we're using for the long game? And the long game is not our focus now. And I'm sort of coming around to this idea. People differ on this idea of memory medications. So we're talking about cholinesterase inhibitors, mammantine. Um, when when the cognitive decline is so severe, maybe these medications are no longer giving benefit. They certainly can have side effects. So, you know, just looking at this patient and what are they benefiting from? And if they're not, do we want to get rid of it? Those I find that those conversations about memory meds are highly emotionally charged with families. So that's a difficult one, but it's something to think about.
SPEAKER_01Right. When you think about overall quality of life, trying to tease out the benefit of those is very difficult generally. So to say whether or not it would have dramatically affects someone's quality of life if they do or don't continue it is so hard to predict. But quality of life also is affected by pill burden and needing to make sure people are taking medications on a daily basis. And so, yeah.
SPEAKER_02Yeah, that's another target population. You know, if I see on a chart a patient that's refusing their medications, right? We've got some medications that you miss a dose, you're gonna have withdrawal side effects. So if a pay, you know, or rebound effects. And so if a patient's frequently refusing medications, then I'm gonna look at that regimen from from that standpoint and saying, okay, what do we what can we get down to that's absolutely necessary? If the pill, if the pill pile was five instead of 10, maybe they would be more likely to take those medications. Maybe there's swallowing difficulties. So, you know, do we need that big calcium pill anymore? Right, maybe not. So yeah, I I have my you know likely targets, but in reality, every single medication on that regimen is a possibility given the sort of patient situation.
SPEAKER_01Yeah. Medication and supplements, too, because they they may also add up and uh as you say, questionable benefit depending on the product and stage of life and all of those things. Right. Yes, absolutely. Yeah, great call out. And I I appreciate that you called out the the effects on medications that may be contributing to falls, which could include hypoglycemia meds, hypotension, you know, meds that can cause hypotension. Those are sort of, I think, maybe more likely to fall under the radar because you you don't think of them as those anticholinergics or the the benzos, those higher risk sort of medications. So I I appreciate you calling that out. And you actually made me think too, deprescribing isn't just for older adults, because if we're thinking about patients, for example, taking a GLP1 agonist who's lost a lot of weight and may not need their antihypertensives or their diabetes medications to the same extent that they have in the past. We could be thinking about other patient populations here. I know that's your expertise, but there are other patients who could benefit from deprescribing. And I think as pharmacists, we are thinking about that regardless of the patient. Right.
SPEAKER_02Yeah. No, I'm a geriatric pharmacist. I try to stay in my lane. You that's an important point that you make. And I want to point out one more of the resources that you're going to share with our listeners that I think is really good. Um, this um this guideline from um the American Academy of Psychopharmacology, I might have that a little American Society of Clinical Psychopharmacology Task Force is what it is.
SPEAKER_01It's quite a mouthful, yes.
SPEAKER_02Yeah. So another population that they pointed out that I've kind of you know avoid in my um expertise, but is is pregnant patients. You know, so there are some risk with certain psychiatr, you know, psychiatric drunks. Um, and so you really do have to play that risk-benefit, you know, um game and figure out, okay, what's what's important here, and should we be reducing risk by reducing doses or maybe choosing a different medication? So yeah, you're right. It's not just for old people, it's for all
Tools That Make Reviews Faster
SPEAKER_02people taking medications, really just saying, okay, is this still needed today? And do the benefits outweigh the risks?
SPEAKER_01Absolutely. Just to briefly touch on tools that we can use in practice and going back to sort of the older adult population, we had chatted a little bit before we started about some of those common tools that pharmacists can have in their back pocket to remind us of some of those things like you mentioned about fall prevention and that sort of thing. Could you are there any practical sort of uh resources that we can be thinking about as we're reviewing a med list? Right.
SPEAKER_02There's tons of resources out there. Um, top of mind, um, some of the oldest, best, and they're you know continually updated. Beers criteria. If you're not familiar with Beers criteria, familiarize yourself. Uh last updated in 2023. Stop start. So this is European, um, but stop and start um is kind of unique because it's not just a do-not-use list, but it's also uh the the start criteria is a list of medications that may make a lot of sense and have more benefits than risks in older people. So I think um that's a nice resource, but there's you know continuing um things coming out all the time. I utilize resources from deprescribing that's a Canadian group, and they've got some algorithms. Um, I've utilized the um patient education sources, resources with that, especially with the PPI deprescribing. That's been successful for me for utilizing the education for patients and prescribers. But again, there's stuff coming out all the time this spring. There's there's a good amount of geriatric stuff and expertise in Australia. A lot of certified geriatric, um, board certified geriatric pharmacists in Australia. And there's a clinical guideline from the Medical Journal of Australia on deprescribing um that was just put out earlier this spring. So, I mean, literally, I think there's dozens of articles coming out every month. And, you know, I've read some good stuff about deprescribing um overactive bladder medicines, hypertensives, you know, psychotropics, all the things that we've talked about, there's resources out there. And I think that the literature, you know, for sure, we know that deprescribing reduces medications, reduces costs. But the newest stuff is also showing some of the outcomes that we really care about, reduced hospitalizations, reduced mortality, increased quality of life. Those are the bingies that maybe we didn't have a few years ago that I'm seeing more data on now. And that's really exciting because then we can really have some serious conversations with prescribers and patients about this matters. This is important. I'm not taking stuff away. I'm trying to improve your life and extend.
SPEAKER_01Absolutely. Yeah, and it's hard to argue with that. Again, it's going back to the patient at the center of this. We are doing this for your best interest and the example that you gave with the overactive bladder med, and that was the patient's decision to stay on it. And again, it's all going to come down to the benefit risk calculus for that patient. Um and I appreciate you highlighting some of the tools and resources because obviously in this discussion, we can't get into specifics around how you would taper or when to taper on any particular drug class. So there are resources available out there. But I think just to tie back to what you highlighted in the earlier part of the discussion around pharmacists' role in this, and we have such a critical role here, and some of this potential for pharmacists to be reimbursed for these services. If you could talk a little bit more about that, because I think that's something that will be of interest to a lot of our listeners, is many of us maybe already doing this practice every day. How, how, what is the path for reimbursement and and what's changed recently around that?
Payment Paths And New CMS Momentum
SPEAKER_02Right. So, what CMS has shined a light on recently and kind of green lighted in my mind, um, I think we've always kind of wondered like, is this a billable service? Um but uh it seems as though that this is important to you know the powers that beat, right? So if you've got uh if you're a pharmacist and you've got a relationship and you can do incident two billing, deprescribing education and planning, follow-up monitoring, I think those are gonna those are gonna be um important things for you to pursue. And there's billing possibilities there. And so, and again, you've you've got some great resources provided to the listeners um in the notes. So, so yeah, if you're a pharmacist and you are serving older people and you've got that situation where you can do or you can pursue incident two billing, I would encourage you in that. It's been my experience that there are a lot of folks out there in the community that would benefit from this, would would seek this. Um, and so I think it would be a great new service for pharmacists out there to be providing to patients and families. And don't uh don't overlook. Uh, I'm a you know an adult uh caregiver, out of state caregiver. So don't overlook those family caregivers that are in the sandwich generation, I think we call ourselves. I've got I've got teens and young adults and uh and then and you know an older mother that I'm caregiving for. So uh those people and they they uh they need the information, they need your services, and they have the means. And so I think I think this could be a really great new necessary, um, impactful pharmacist service.
SPEAKER_01Mm-hmm. So yeah, to summarize the the national attention around the concept of over-prescribing has with it also brought to the forefront that pharmacists are in this prime position to do this and hopefully help to clarify the opportunity for reimbursement. And again, the clarification was with the incident two billing, but uh pharmacists in any practice setting, doing medication reviews, there's always a cash pay option too. And as you say, these caregivers may be representing their loved ones and and wanting that service as well. So, yeah, just a great reminder of sort of the breadth of opportunity there, I think. And and again, many of us are doing this on a daily basis in practice, and so just being able to get paid for it would be a positive opportunity. Yeah. So in thinking about sort of uh summarizing all of this, we've we've talked about the the myths to be considering the tools that we can be using, the communication aspect with both patients and providers. What else have we missed in terms of what you want to convey to our listeners around best practices for de-prescribing in general? Any any sort of general guidelines or key takeaways that we should be thinking about besides what we've discussed already?
SPEAKER_02Sure.
The Game Changer And Closing
SPEAKER_02Um so I think that uh deprescribing should be viewed as routinely as prescribing. You know, the medication regimen should be scrutinized uh annually, if not more often. Pharmacists are uniquely advantaged with medication knowledge, but also a relationship with their patients, and that's one of the keys to success. Also, communication, clear plans, monitoring, and follow-up. But but yeah, that's really the package. You know, um, this should be routine. Pharmacists are uniquely advantaged in that arena, and when done, um uh in a kind of a methodical process with education and follow-up can be very successful.
SPEAKER_01Absolutely. I think that's a great summary. And I love the idea of deprescribing it is the converse to prescribing, but you're thinking you should be thinking about it the same way that you would think about prescribing, think about deprescribing. They go hand in hand, they should go hand in hand. And that also the risks and benefits for any given patient evolve with time to and so that follow-up, that's where that follow-up and monitoring really come into play. Yeah. Absolutely. Absolutely. Well, to wrap up our discussion, this is our game changers uh podcast. So is there one game changer you would walk our want our listeners to walk away with? Sort of that one-line bottom line. Um, I think you summarized it very well in your your prior statements, but any key, you know, one-liner that we should walk away with.
SPEAKER_02Sure. We've talked about deprescribing before. This is not, you know, um a new concept for most, and you've heard about it from me before. So I think today the game changer is just CMS opening up the floodgates. You know, there's some negative information out there about, you know, we're over-medicating people. But the flip side of that is pharmacists are in a position now to take action and and help people, help prescribers. Um, and so I'd say the game changer is take advantage of this opportunity to serve your aging patients. Um, they need you, and and you're ready.
SPEAKER_01I love it. Thank you. Thank you, Kristen. This is a great discussion, very practical, and I love the examples you shared. I think I've I've walked away with some very practical advice I can apply to my practice. So thank you so much. Appreciate your time. Thank you, Rachel. Always a good time.
SPEAKER_00Excellent. And that's it for this week. Be sure to log in to Healthmart University to claim your CE credit for this episode. As always, have a great week and keep learning. We'll talk to you next week.