More innovative, intensive approach to medication management required

Treating mental health with medications is very different from treating an infection, so why do many people, and many employers, treat them like they’re one and the same?

When enhancing communications around wellness programs, plan sponsors should seek innovative ways to support employees with how they use medications and help them understand the interactions between drugs and mental health, said Jeff May, executive vice-president and general manager at Remedy Holdings Inc.

Read: Panel discussion: Hot topics in drug plan management

“We need to include a more intensive approach to medication management for people, particularly those who are off work,” he said during a session at the 2018 Mental Health Summit Vancouver on Dec. 11. “When we talk about medications for mental health, they’re very effective when tolerated. Psychotherapeutics are definitely up there. There are multiple medication choices, from treatments for simple anxiety to more intensive treatment for schizophrenia or bipolar disorder and across the spectrum of medications for mental health, but side-effects are very common, particularly in early therapy.”

Many medications that treat mental-health disorders require six to eight weeks — or more — to get the full effect, said May, noting this isn’t often considered. And the interactions between those early side-effects, which may include drowsiness and irritability, are what can affect a person’s performance at work, he added.

“All those things need to be managed, especially in those early days. We also see that [where mental health is concerned] 60 per cent of people aren’t adherent to their medication at six months of treatment. So they’re falling off because of side-effects.”

Read: The costs, benefits of pharmacy services on private drug plans

A more active intervention between pharmacists and employees is required, said May. “[Generally speaking], there isn’t a pharmacy or medication management component as part of our return-to-work strategies. So we did a pilot study with about 100 individuals working with a group of consultant pharmacists and a disability management group. Our focus was on mental health and pain management.”

The study found gaps in patient knowledge about what their medication was for and how to use it. “The reality is there were 16 per cent of people [in the study] who reported something wasn’t working the way they wanted it to and 21 per cent reported they weren’t taking their medications as prescribed, which is actually lower, but it’s self-reported. And 13 per cent of the cases required some kind of a change in therapy.”

Read: Successful management of speciality drugs requires a multi-pronged approach

When the study went through the process with plan members, it found 87 per cent became adherent and 82 per cent reported a resolution to the side-effects based on pharmacist recommendations.

“Employers incur costs when people aren’t adhering to their medications because of side-effects, because of the fact that they aren’t achieving the outcome we want — reducing the depression and the anxiety so they can perform better at work,” said May. “Based on these studies, very simply, keeping an individual off work can generate additional savings of $270 per adherent employee just by taking their meds, not to mention the other opportunities that exist with this type of a program.”

Read more coverage from the 2018 Mental Health Summit Vancouver