Medication Adherence Program for Medicare Advantage

Las Vegas—A retrospective analysis of claims data from a Medicare Advantage prescription drug plan found that a comprehensive medication adherence program benefitted prescribers and members. From 2012 to 2013, New West Medicare’s adherence rates increased by 3 percentage points for oral diabetes drugs, 3 percentage points for hypertension medications, and 5 percentage points for cholesterol drugs. For each measure, New West Medicare maintained a 5-star rating (the top rating) in the Centers for Medicare & Medicaid Services (CMS) Star Ratings system.

Results were presented during a poster session at the PBMI conference. The poster was titled A Multi-Channel Medication Adherence Program Aimed to Influence Patient and Prescriber Behavior and Increase CMS Star Ratings.

The authors said that the CMS Star Ratings provide beneficiaries the opportunity to compare Medicare Advantage plans on numerous quality of care measures. They said that medication adherence for oral diabetes, hypertension, and cholesterol drugs carry triple the weight of other measures and provide 11% of a plan’s Star rating and 32% of its Part D rating. Starting in 2015, plans are required to have ratings of ≥4 stars to receive bonus payments.

In April 2013, MedImpact and New West Medicare collaborated on an adherence program to maintain Star ratings and influence patient and prescriber behavior. MedImpact is a pharmacy benefit manager covering ≥47 million lives throughout the world, while New West Medicare is a Medicare Advantage plan with headquarters in New Mexico and covers approximately 20,000 members.

The adherence program consisted of daily prescriber-directed, retail-based, 90-day fill letters and weekly CMS-approved member-directed refill reminder letters. From April 15, 2013, through December 31, 2013, the authors faxed 6411 prescription letters to 967 prescribers. The prescriber response rate was 57.4%, and the prescriber approval rate was 49.9%. The average number of refill reminder mailings was 1716 per month, while the overall refill rate was 38.5%.

From March 2013 to December 2013, the proportion of 90-day claims increased 26 percentage points for oral diabetes drugs, 21 percentage points for hypertension medications, and 24 percentage points for cholesterol drugs. For all 3 medication categories, New West Medicare’s adherence rates improved more than the average Medicare plan in the 3 months after the program began: an improvement of 9 percentage points for oral diabetes, 7.8 percentage points for hypertension, and 9.2 percentage points for cholesterol.

Based on the findings, the medication adherence programs have been implemented in other MedImpact health plan populations, according to the authors.

The authors noted that 90-day programs are sometimes criticized for promoting medication waste, but patients were required to fill their prescriptions instead of having their prescriptions automatically refilled for them and sent through the mail. In addition, 10% of New West Medicare’s members receive low-income subsidies, which has been associated with higher disease burden and lower adherence compared with people who do not receive such subsidies.

Limitations of the study, according to the authors, included that some members may have appropriately discontinued medications based on provider recommendations, and actual adherence may differ from observed adherence, as measured by claims data.