OBJECTIVES: To identify and characterize medication-related issues among elderly community-dwelling individuals with polypharmacy. To contact physicians about advancing quality care through modification of complex drug regimens, either by eliminating unnecessary drugs or by revising therapy to reflect standards of practice. METHODS: An intervention program was conducted in retirees from a large corporation. Individuals with 9 or more different medications present in their pharmacy claims data over a 3-month period were selected. Cases were developed by combining demographic, medical, and pharmacy claims data, and sent for review by Omnicare's consultant pharmacists. Based on quantitative and qualitative review, recommendations were made on behalf of each retiree at moderate to high risk and the appropriate physician contacted by telephone or fax. RESULTS: A total of 488 polypharmacy cases were identified from a sample of 14,000 retirees, of which 309 were eligible for inclusion. An average of 12 medications was prescribed to these individuals. A total of 61.8% had safety, quality, or cost issues of moderate to high risk requiring intervention. In 49.1% (152) of all reviewed cases, medication safety issues were present. Most instances involved an inappropriate medication for use in the elderly. Recommendations for improved management of coronary heart disease and stroke were addressed in 34.0% (105) and 19.4% (60) of the cases, respectively. Other key recommendations involved aspirin use, Cox-2 Inhibitor use in retirees with heart disease, medications associated with increased risk of falls and fractures, and untreated osteoporosis. Recommendations were accepted by over half of responding physicians. CONCLUSIONS: Inappropriate medication use continues among elderly persons treated with multiple agents. Pharmacist intervention with physicians can improve prescribing in this population.