The objective of this practice and research network opinion paper was to identify literature for pharmacist-led services with obesity management, summarize clinical evidence for this disease state, and describe the role of a clinical pharmacist among patients who are overweight or have obesity. Clinical pharmacists play a critical role in the safe and effective management of obesity in both the inpatient and outpatient settings. In an outpatient setting, the role of the clinical pharmacist includes a comprehensive patient interview to design an individualized therapeutic plan involving nonpharmacological interventions with or without pharmacological interventions or surgical options. A clinical pharmacist conducts a risk-benefit analysis for pharmacological interventions. Furthermore, the potential of medications to contribute to weight gain or prevent weight loss can be reviewed by a clinical pharmacist when managing comorbid conditions. In an inpatient setting, a clinical pharmacist conducts medication reconciliation, determines appropriate supplements for nutritional deficiencies, and provides medication management for people with obesity who may or may not be undergoing bariatric surgery. In addition, a clinical pharmacist can provide thorough patient education with monitoring for transitions from hospital to the outpatient setting and subsequent follow-up visits.
Cost can be a barrier to achieving health equity for guideline-directed medical therapy; however, ambulatory care pharmacists who provide services in primary care settings can assist in reducing these barriers. Strategies to reduce drug cost should be tailored to patient-specific factors including insurance type, drugs being prescribed, and availability of local and national assistance programs. Pharmacists can use a team-based approach, when possible, to promote health equity in drug access due to cost. The authors provide recommendations that can be incorporated into clinical practice and improve health equity.ambulatory care, drug cost, health equity, pharmacy, prescription, social determinants of health
| INTRODUCTIONDrug cost is a barrier to patients obtaining guideline-directed medical therapy (GDMT). 1 Several clinical practice guidelines recommend drug classes that only include agents available as brand name products.These products have significant retail costs, which many patients are unable to afford with or without prescription insurance. Most prescription insurance companies cover brand name drugs at higher tiers, and therefore, require a higher copay and out-of-pocket expense to the patient. While the Affordable Care Act (ACA) has improved insurance access, drug cost can still leave many GDMTs unobtainable due to high deductibles and/or copays. 2 A 2021 West Health-Gallup poll revealed that 18 million Americans cannot afford their drugs, in particular, patients with three or more chronic conditions, eight or more drugs, and households earning less than $24 000/year. 3 This means patients with chronic conditions who cannot afford brand name GDMTs may opt to be treated with older, inferior drug therapies. 2
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