Polypharmacy rarely starts with a mistake. It starts with care.
Nearly 42% of adults 65 and older are taking five or more prescription medications, and 12% are on ten or more at the same time, a pattern associated with a higher risk of drug interactions and adverse outcomes. For payers, that creates cost pressure on two fronts: higher pharmacy spend today and the risk of potential higher medical spend later should an adverse drug issues drive downstream care. When regimens include unnecessary or duplicative therapies, the waste adds up quickly, and so do the avoidable safety risks.
When “one more medication” becomes a hidden safety and waste problem
The danger of polypharmacy isn’t limited to drug interactions or side effects. It shows up in duplication, overlapping therapies, and oversupply. Patients end up managing regimens that are difficult to follow and even harder to reassess. Caregivers juggle refills, timing, and instructions that no longer reflect a patient’s current needs.
Unused medications pile up at home. Automatic refills continue. Early shipments arrive before the last supply is gone. None of this looks dramatic in isolation, yet the cumulative effect is significant.
From a payer’s perspective, this waste often flies under the radar. Prescriptions are filled as written, and the claims data often looks routine.
The opportunity for payers and plan sponsors
Plans and payers are positioned to detect polypharmacy patterns early. Claims data can flag duplication, overlapping drug classes, high-risk combinations, and chronic oversupply long before the consequences show up. The problem is follow-through. If the only response is a retrospective review or a member-facing tool that requires extra work, change is less likely.
A better approach is to support prescribers and offer them full visibility into their patient’s prescription list with patient-specific recommendations, such as therapeutic alternatives aligned to the plan’s formulary, opportunities to discontinue duplicate therapy, or adjustments to quantity and days’ supply, through the same channels clinicians already use. The most useful interventions come with a clear clinical rationale: the expected member and plan savings, and a prescriber-ready notification that can be acted on quickly. When the right information is easy to act on, unnecessary therapy is easier to identify and remove.
The payoff is practical and immediate. Fewer unnecessary medications mean fewer interactions, fewer side effects, and clearer treatment plans. They also mean less spending on drugs that no longer deliver medical value.
This is not about limiting care; it’s about aligning treatment with what patients need today, rather than maintaining regimens that have outlived their purpose. Simplifying medication use supports adherence, reduces confusion for patients and caregivers, and removes waste.
One of the fastest ways this shows up is oversupply.
The oversupply problem is larger than most realize
Oversupply is one of the least discussed contributors to pharmacy waste, but it directly fuels polypharmacy by keeping patients on medications longer than clinically necessary. Early refills and automatic dispensing may be convenient, but that convenience can quietly fuel excess medication and potentially dangerous interactions.
The cost impact of this excess alone is substantial. Recent reports and analysis from The Wall Street Journal in early 2026 show that Medicare patients received roughly $3 billion worth of extra drugs from pharmacies, driven by early refills and oversupply. Mail-order pharmacies can amplify this pattern. Between 2021 and 2023, these pharmacies accounted for 9% of Medicare prescriptions, yet represented 37% of excess dispensing. Because the fills follow standard rules and timelines, oversupply can look routine until the downstream effects surface.
Why polypharmacy hides in plain sight
There is no shortage of consensus around polypharmacy. Clinicians understand the risks, and deprescribing is widely supported in principle. Simpler regimens improve adherence and safety.
The barrier, in practice, is execution.
Medication reviews take time. Identifying overlapping drug classes requires clean data and clinical context that many providers do not have readily available. Providers working under different health systems may not have access to their patient’s total medication histories. Changes that require extra steps, new portals, or administrative follow-up often stall, even when everyone agrees a change would help the patient. Polypharmacy persists not because providers don’t care, but because the system rarely makes the right action the easy one.
Fortunately, technology platforms can synthesize a patient’s prescribing history and provide clinicians with the necessary data and analysis, enabling more accessible and effective decision-making around deprescribing. These platforms continuously scan pharmacy claims, plan rules, and formulary information to identify medication switching, deprescribing and deduplication opportunities, then deliver prescriber-ready recommendations inside existing workflows. Many also route accepted changes to the pharmacy and notify members, creating a closed loop that helps ensure the updated regimen is filled correctly and unnecessary refills stop.
Polypharmacy is a strategic issue, not a clinical footnote
As care becomes more specialized and patients see more providers, polypharmacy continues to grow unless intervention is enabled.
Polypharmacy is a cost and safety problem that is solvable. The right technology platform can reduce it by identifying risky regimens, route specific “stop/switch/consolidate” opportunities to clinicians, and track whether changes stick through refill and adherence patterns.
That closed-loop approach is where safety improves and pharmacy dollars stop leaking.
Photo: Daniel Ingelhart, Getty Images
Tom Dorsett has 27 years of experience as a healthcare entrepreneur and business development executive. He founded and exited two successful companies, NuScribe and ePatientFinder, and co-founded RazorMetrics in 2018 to lower drug spend for self-funded employers and health plans.
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