Polypharmacy Notice for Multiple Anticholinergic Medications in Older Adults
Date: 12/17/25
Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults
At Wellcare, we value everything you do to deliver quality care to our members — your patients. We appreciate your commitment to their positive healthcare experience.
POLY-ACH Measure
The POLY-ACH measure in the Centers for Medicare & Medicaid Services (CMS) Star Ratings evaluates health plans based on the concurrent prescribing of two or more anticholinergic medications for a significant period.
| Quality Measure | Description |
|---|---|
| Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (POLY-ACH) | Percentage of patients ages 65 years or older with concurrent use of two or more unique anticholinergic medications for 30 cumulative days. |
| POLY-ACH Exclusions | Patients enrolled in hospice. |
| Who qualifies for the measure? | Members, ages 65 years and older, with at least two prescription claims for the same anticholinergic medication with different dates of service |
| Who is considered to be non-compliant with the measure? | Members who have at least two prescription claims of at least two unique anticholinergic medications with 30 days of overlapping use. |
Action
We have listed applicable therapeutic categories and anticholinergic medications below for easy reference. Please consider avoiding initial use of multiple anticholinergic medications in the elderly and discontinue medications, as appropriate.
Tips for Success
- Monitor progress/follow-up with each appointment and taper down if taken long-term or high dose.
- Limit prescriptions on an as-needed indication (no refills, etc.).
*Note: This is not an all-inclusive list.
| Antihistamines | Antiemetics | Antidepressants |
|---|---|---|
| Cyproheptadine | Prochlorperazine | Amitriptyline |
| Hydroxyzine | Promethazine | Nortriptyline |
| Meclizine | Paroxetine |
| Skeletal Muscle Relaxants | Antipsychotics | Antimuscarinics |
| Cyclobenzaprine | Chlorpromazine | Darifenacin |
| Orphenadrine | Clozapine | Oxybutynin |
| Olanzapine | Trospium |
Rationale
These recommendations are based on the American Geriatrics Society (AGS) Beers Criteria® list of potentially inappropriate or unsafe medications best avoided by older adults ages 65 and up. The list, updated by the AGS every three years, serves to help reduce adverse effects and improve patient safety.
2023 American Geriatrics Society Beers Criteria® for Potentially Clinically Important Drug Interactions That Should be Avoided in Older Adults Ages 65 and Up.
| Drug Class | Interacting Drug Class | Risk Rationale |
| Anticholinergic | Anticholinergic | Use of more than one medication with anticholinergic properties increases risk of side effects such as dry mouth/eyes, impaired cognition, urinary retention, sedation, delirium, and risk of falls leading to fractures. |
We recognize that you are best qualified to evaluate the potential risks versus benefits in choosing the most appropriate medications for your patients.
Reference: Alternative Treatments to Selected Medications in the 2023 American Geriatrics Society Beers Criteria®