Deprescribing Is an Important Beginning. Medication Stewardship Is the Future.
A response to the recent article by Dr. Sara Rogers discussing new CMS guidance on deprescribing, by DisposeRx CEO, William Simpson
Dr. Rogers article on deprescribing (found HERE) highlights an important shift in how healthcare is beginning to think about medication management.
The guidance recognizes the clinical value of helping patients safely reduce or discontinue medications that are no longer appropriate and acknowledges the critical role pharmacists can play in that process. It is an important development not simply because of new reimbursement opportunities, but because it signals something much larger. Healthcare is beginning to recognize that prescribing a medication is only one chapter in the patient’s journey.
For generations, American healthcare has measured success by getting patients started on the right medication. We have invested tremendous resources in diagnosing disease, prescribing appropriately, manufacturing medications safely, dispensing them accurately, and improving adherence. These efforts have transformed modern medicine and improved countless lives.
Yet one important question has received far less attention: What happens after treatment ends?
Every medication has a lifecycle. It is prescribed, dispensed, taken, monitored, adjusted, and eventually completed, changed, or discontinued. At every stage, patients need guidance, education, and support. Unfortunately, our healthcare system has often treated these stages as separate activities rather than as one continuous responsibility.
It is time to recognize that this responsibility deserves a name in the care continuum and that name is, Medication stewardship.
Medication stewardship begins when a medication is prescribed and ends only when that medication no longer presents a risk to the patient, the caregiver, or the home. It includes selecting the right therapy, educating patients, supporting adherence, monitoring outcomes, periodically reassessing whether the medication is still appropriate, safely deprescribing when necessary, and responsibly managing medications that remain after therapy has ended.
The recent CMS guidance represents an important milestone because it recognizes that helping patients safely discontinue medications requires clinical expertise and should be supported as valuable healthcare. Pharmacists have quietly performed this work for years, often without formal recognition or reimbursement. Expanding their ability to provide these services is good for patients, good for healthcare, and good for our communities.
But deprescribing should not be viewed as the finish line. It is one chapter in a much larger story. Deprescribing answers an important clinical question: “Should this patient continue taking this medication?” Medication stewardship asks one additional question: “What happens to the medication once that decision has been made?” It is this question that has both social implications and societal cost ramifications and it is within this question where we can begin to make a generational change.
Too often, the answer is that it remains in a kitchen drawer, bathroom cabinet, bedside table, or medicine cabinet, where it may contribute to accidental poisonings, medication confusion, diversion, misuse, or environmental concerns. Completing therapy should also include a plan for responsibly managing medications that are no longer needed. Only then can we truly say the prescription journey is complete.
For decades, healthcare has focused on helping patients begin therapy safely. The next generation of healthcare must place equal emphasis on helping patients complete therapy safely.
That shift becomes even more important as Americans live longer, manage multiple chronic conditions, take more medications, and increasingly choose to age in place. Medication management is no longer simply about taking the right medication. It is about continually ensuring that every medication remains appropriate for the patient’s changing health, goals, and quality of life and that when therapy ends, the medication no longer creates unnecessary risk within the home.
Community pharmacists are uniquely positioned to lead this transformation.
No healthcare professional has more frequent opportunities to educate patients, identify medication-related problems, coordinate with prescribers, support caregivers, and help families navigate the complexities of medication management. Their role is no longer defined solely by dispensing medications. Increasingly, it is defined by helping patients use medications safely, effectively, and only for as long as they continue to provide meaningful benefit.
Medication stewardship also extends beyond the patient. It protects families and caregivers. It supports safer homes and strengthens communities. Every prescription creates an opportunity not only to improve health, but also to reduce preventable harm through education, reassessment, and thoughtful planning for what happens when treatment is complete. This is why every care plan should include an end-of-therapy plan.
Patients deserve to know not only how to begin treatment safely, but also how therapy will be monitored, when it should be reassessed, whether it should eventually be tapered or discontinued, and how any remaining medication should be responsibly managed once it is no longer needed.
This is not simply good clinical practice. It is good public health. The recent CMS guidance has opened an important door. Now it is up to healthcare leaders, pharmacists, physicians, policymakers, and patients to walk through it.
Medication stewardship should become an expected part of every prescription journey not an exception reserved for the highest-risk patients. Because the true measure of a prescription is not simply whether it was filled. It is whether the patient completed that journey safely.
I leave you with a Medication Stewardship Challenge:
The next time you receive a prescription, ask one additional question: “When my treatment is complete, what’s the plan?”
Ask these five questions:
Do I still need every medication I’m taking?
How will we know when this medication should be stopped or reassessed?
Are any of my medications increasing my risk of side effects, falls, or interactions?
What should I do with medications I no longer need?
How can I make my home safer for my family and caregivers?
Talk with your pharmacist and healthcare team—including your physician, nurse practitioner, or care coordinator—about building an end-of-therapy plan that is right for you.
Every patient deserves more than a safe beginning. They deserve a thoughtful, risk free ending too.
Because when treatment is complete, our responsibility is not. It continues until the patient, the caregiver, and the home are safer than they were before care began. That is the promise of medication stewardship.
