Rethinking more meds as better medicine
In today’s fast-evolving healthcare landscape, one of the most transformative shifts in pharmacy isn’t about inventing new drugs, it’s about letting go of old ones. The practice of deprescribing, once considered a radical idea, is now gaining traction as a core clinical competency for pharmacists. And as medication regimens grow increasingly complex, the need for this skill has never been more urgent.
The Hidden Dangers of Polypharmacy
Consider this: nearly 40% of older adults take five or more medications each day. While some of these prescriptions are lifesaving, others may be outdated, duplicated, or even causing more harm than good.
- Medications with no current indication
- Drugs prescribed to treat the side effects of other drugs
- Therapies that were once necessary but no longer make clinical sense
This isn’t just a case of inefficiency. It’s a serious threat to patient safety. Adverse drug events, hospitalizations, falls, and cognitive decline can often be traced back to polypharmacy and many of these events are preventable through thoughtful deprescribing.
Why Pharmacists Are Uniquely Positioned to Lead
Pharmacists bring a distinct and powerful perspective to the deprescribing conversation. We are the professionals who:
- See the full medication picture, not just a single therapeutic area
- Understand the pharmacokinetics and pharmacodynamics of each drug
- Spend time with patients who openly share how medications affect their lives
We hear what patients won’t tell their doctors. We know when a pill no longer makes sense. And increasingly, we are stepping into the role of trusted advisors, not just dispensers of medication, but stewards of medication appropriateness.
Deprescribing: More Than Just Stopping Meds
Deprescribing is not about simply slashing prescriptions. It’s about optimizing therapy with precision and care. This requires:
- Deep clinical reasoning
- Familiarity with tools like the Beers Criteria and STOPP/START guidelines
- Strong, compassionate communication with both providers and patients
Telling a patient or prescriber that it’s time to stop a medication isn’t easy. It takes confidence, a collaborative plan, and a clear communication strategy that invites trust instead of fear.
Aligning with Value Based Care
Deprescribing directly supports the principles of value-based care:
- Fewer adverse events
- Lower healthcare costs
- Improved patient outcomes
Health systems and payers are paying attention and pharmacists who can lead deprescribing efforts are becoming indispensable. Already, we’re seeing innovative models emerge:
- Deprescribing consult services within MTM and chronic care management
- Integration into telehealth and remote patient monitoring
- Development of direct-pay clinical services focused on medication optimization
A Mindset Shift and a Movement
Ultimately, deprescribing represents more than a clinical skill, it’s a philosophical shift. It’s a move from reflexively treating every symptom with another pill, to asking deeper questions: Is this medication still necessary? Is it helping or harming? Can we do better with less?
Pharmacists have the training, access, and patient trust to guide this change. Those who embrace deprescribing won’t just reduce pill counts, they’ll elevate the profession and redefine what it means to practice pharmacy in the 21st century.
In the end, deprescribing is not about doing less. It’s about doing what truly matters.
