Medicines accumulate. A prescription from one specialist, another from the family doctor, something bought over the counter for sleep, a supplement a friend recommended, and a bottle from last winter that never quite got finished. Each made sense when it arrived. Nobody has looked at all of them together, and that is the gap a medication review exists to close.
A medication review is a structured look at every medicine a person takes, prescription and over-the-counter, plus vitamins and supplements, with a pharmacist or doctor, to check that each one still has a reason and that they work together. In the United States, many Medicare drug plan members can get one free.
What a medication review is
The Pharmaceutical Care Network Europe, a research network of pharmacists, agreed a definition in 2018 that is now widely used: a medication review is a structured evaluation of a patient’s medicines with the aim of optimising medicines use and improving health outcomes. The important word is structured. It is not a quick “any questions?” at the end of an appointment. It is a deliberate pass through everything, one item at a time.
What it is not is also worth saying clearly. A review is where the professionals look at the whole picture and decide whether anything should change. It is not a moment for the patient or family to make changes on their own, before or after; any change is for the prescriber to decide. The family’s job is to bring complete information; the prescriber and pharmacist do the reviewing.
Where to get a medication review in the United States
There are three common routes, and two of them are free for most people who qualify.
Medication Therapy Management through a Medicare drug plan. Medicare.gov explains that plans with Medicare drug coverage must offer Medication Therapy Management services to people who meet certain requirements or are in a drug management program. Medicare.gov suggests that people taking medicines for several chronic conditions contact their plan to find out whether they qualify, and that call is the simplest first step. If they do, the services are free. Medicare describes what they include:
- a discussion with a pharmacist or health care provider to review the person’s medicines;
- a comprehensive review of the medicines and the reasons for taking them;
- a written summary of the review;
- a “Recommended To-Do List” and a “Medication List” to take home.
The yearly wellness visit. Medicare’s annual wellness visit includes a review of current prescriptions. Medicare.gov says the person pays nothing for the visit if the provider accepts assignment, although the Part B deductible may apply if additional tests or services are done in the same visit. A wellness visit review is shorter than a full medication therapy management session, but it is a natural moment to raise the whole list.
Any pharmacist. Outside those programs, most community pharmacists will go through a medicine list if asked, especially if the person fills their prescriptions there. It helps to ask for a quiet time rather than the busy end of the day.
Why Open Enrollment is a good time
Medicare’s Open Enrollment runs from 15 October to 7 December each year, with changes taking effect on 1 January. It is the period when people can join, drop or switch Medicare drug plans. A drug plan choice depends on exactly which medicines a person takes, so an up-to-date, reviewed list is useful twice over at this time of year: once for the review itself, and once for comparing plans. If a review is going to happen at some point anyway, doing it before the list is used to compare plans makes sense.
How to prepare: bring everything, literally
FDA’s advice for older adults is to tell the whole health care team about all the medicines being taken, including prescription and over-the-counter medicines, and to keep a record that includes dietary supplements, vitamins and herbal products. The most reliable way to make that record complete is to put every container in one bag and bring the bag. Pharmacists sometimes call this a brown bag review.
What goes in the bag:
- Every prescription bottle, including ones prescribed by different doctors and ones that are rarely used.
- Every over-the-counter product, including sleep aids, pain relievers, antacids, allergy tablets and creams.
- Vitamins, supplements and herbal products, in their original containers so the ingredients are visible.
- The pill organizer, filled as it currently is. Seeing what is actually in each compartment often reveals more than the list does.
- Anything unidentified, such as a loose tablet found in a drawer. The pharmacist can identify it from its imprint and say whether it belongs to the current regimen.
Bring the written list too, even though the containers are there. The list shows how the person actually takes each medicine, which is sometimes different from what the label says, and that difference is one of the most useful things a review can uncover. The fields worth recording are set out in the medication list template.
Questions worth writing down in advance
FDA suggests making a list of questions or concerns before any visit or call to a health care professional. For a medication review, a few questions tend to earn their place:
- Is each of these medicines still needed, and what is each one for?
- Are any of them doing the same job as another?
- Do any of them interact with each other, or with any over-the-counter product or supplement on the list?
- Can any of these tablets be crushed or split, if swallowing is becoming difficult? The reasons some cannot are covered in the do not crush list.
- Which of the over-the-counter products are worth keeping? How to read their labels is explained in what OTC means.
- Is there anything here we should dispose of?
After the review
A good review ends with something on paper. Under Medication Therapy Management that is the written summary, the to-do list and the medication list. After any other kind of review, ask for the same: a written list of what changed, if anything, and an updated medicine list.
Then update the household system straight away, while the details are fresh. Replace the old list, adjust the pill organizer only as the prescriber or pharmacist instructed, and take anything that is no longer needed to a take-back point. If a caregiver shares the job with siblings or a care worker, send everyone the new list the same day. The wider setup for running a parent’s medicines across a family is covered in medication management for elderly parents.
The first review takes the most gathering. After that, with the list kept current, each one starts from an accurate picture.
Sources
- PCNE definition of medication review: reaching agreement, International Journal of Clinical Pharmacy (2018), PubMed
- Safety checks, drug management programs, and Medication Therapy Management, Medicare.gov
- Yearly Wellness Visits, Medicare.gov
- Open Enrollment, Medicare.gov
- As You Age: You and Your Medicines, U.S. Food and Drug Administration