Gold Stars for Stellar Adherence


Medicare Advantage and other supplemental Part D plans encourage medication adherence to achieve higher star ratings.

Medicare Advantage and other supplemental Part D plans encourage medication adherence to achieve higher star ratings.

This rating system measures insurance plan quality, as higher quality plans improve patient outcomes and minimize costs. Adherence represents 10.9% and 29.5% of Medicare Advantage and supplementary plans’ star ratings, respectively. The rating system focuses on statin, renin angiotensin aldosterone system (RAAS) antagonist, and noninsulin antidiabetes medication adherence.

Community pharmacies across the United States have initiated automatic refill programs to improve adherence. These programs have the added benefit of boosting insurance plans’ star ratings. Automatic refills eliminate the need for patients to request a refill by phone or in person.

The Centers for Medicare and Medicaid Services (CMS) confidently assumes that patients of brick-and-mortar pharmacies use their refills if they pick up the prescriptions. This differs from the usage of mail-order pharmacy delivery contents.

Recently, a team of University of Wisconsin-Madison researchers reported that an automated prescription refill program improved medication adherence of Medicare Part D patients.

They retrospectively analyzed prescription refills during 2014 at a 29-location chain pharmacy. Pharmacy employees recruited between 20% and 25% of patients receiving chronic medications into an automated program that refilled prescriptions 7 days in advance of calculated need. CMS defines adequate adherence as at least 80% of days covered by filled supply.

Patients in the automatic refill program were 51%, 20%, and 44% more likely to be adherent to statins, RAAS antagonists, and noninsulin antidiabetes medications, respectively.

Easing barriers to refilling prescriptions enhances adherence, and reinforced adherence enhances pharmacy sales directly and indirectly. Insurance companies prefer pharmacies that strengthen their star ratings; they’re less likely to engage with pharmacies with mediocre adherent patient populations from coverage, and they provide bonuses to pharmacies for high adherence.

The assumption that patients consumed all picked-up prescriptions was a study limitation. Other measures of adherence (pill counts and self-reporting) are imprecise, as well. Patients may have picked up the refills even if their prescriber discontinued the medication. Automatic refills may spur redundant prescribing and drug—drug interactions. Voluntary enrollment may bias toward higher adherence. Refill data collected on the plan-level is superior to pharmacy-level data because patients could have obtained a prescription from outside the chain.

This automatic prescription refill program promoted medication adherence. Improved medical adherence reflects favorably on insurers’ CMS star ratings for quality and promises financial benefit for collaborating pharmacies. Future studies assessing the impact of automatic refill programs should develop a superior method of measuring actual medication intake.

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