Pharmacy Intervention Reduces Improper Drug Combinations

Pharmacy Intervention Reduces Improper Drug Combinations

The Challenge

Atypical antipsychotics — tranquilizing medications used to manage psychosis — account for about 12 percent of total prescription drug spending in the U.S. When prescribed incorrectly, they can raise health care costs unnecessarily.

Treating schizophrenia patients with more than one atypical antipsychotic can increase the risk of side effects or drug interactions. It also decreases the likelihood that patients will follow prescribing instructions accurately.

The American Psychiatric Association recommends prescribing one atypical antipsychotic medication for patients with schizophrenia, unless single-drug therapy fails multiple times.


Our client, a New England state Medicaid program, asked Commonwealth Medicine’sClinical Pharmacy Services team to determine whether a clinical intervention was needed to reduce the costs and risks of polypharmacy with this population.


Our pharmacy consultants collected and analyzed claims data and prescribing trends. The data showed the number of patients receiving antipsychotic therapy was inconsistent with current guidelines:

  • Of 145,000 Medicaid members in the state, 480 were taking two or more atypical antipsychotic drugs.
  • Patients transitioning to new medications needed no intervention.
  • The 172 patients receiving two or more atypical antipsychotics for longer than 60 consecutive days required clinical intervention.

Our pharmacy staff sent providers a formal, patient-specific letter and encouraged them to initiate a doctor-patient conversation regarding appropriate treatment. All prescribers were asked for the following information:

  • A close review of information provided
  • Validation of clinical programs
  • Assessment of need for clinical intervention

Our staff followed up with providers who did not respond. To assess the impact on therapy, we collected and analyzed claims data again six months after the intervention letters were mailed.


In the population originally identified as receiving two or more atypical antipsychotics for more than 60 consecutive days, 32 percent were no longer receiving polypharmacy therapy during the post-letter assessment period. The improvement in prescribing habits among the targeted prescribers resulted in an annualized cost savings of $120,000 for this state Medicaid agency.