Health-System Variables Improve Medication Adherence in Medicare Patients

As the US Centers for Medicare and Medicaid Services places a greater emphasis on medication adherence through its star ratings, pharmacists and other health care professionals continue to seek ways to improve adherence among seniors.

As the US Centers for Medicare and Medicaid Services (CMS) places a greater emphasis on medication adherence through its star ratings, pharmacists and other health care professionals continue to seek ways to improve adherence among seniors.

Now, a new study published in Medical Care has determined that prescriptions with more days’ supply of medication, mail-order pharmacy fills, and lower co-pays and out-of-pocket maximums are all associated with better adherence to drugs for diabetes and cardiovascular disease (CVD).

After finding a dearth of research on adherence among older patients with diabetes and seniors who take medications for CVD risk factors, researchers sought to examine the relationship between the Medicare 5-Star Quality Rating System’s medication adherence metrics and adjustable health-system-level characteristics among older patients with diabetes.

The study involved 129,040 patients aged ≥65 years taking antihypertensive, antihyperlipidemic, or oral antihyperglycemic medications. The 4 health-system variables that the researchers believed were potentially modifiable were average days’ supply of medications, annual out-of-pocket maximum costs, generic drug co-pays, and the percentage of medications delivered through mail-order pharmacies.

The strongest predictor of reaching star-defined medication adherence was a >90-day supply of prescribed medication. In addition, the use of mail-order pharmacies to fill medications was independently associated with better adherence >50% of the time.

While this relationship has been demonstrated in younger populations, the researchers noted that their study was the first to examine the relationship among Medicare-aged patients with diabetes. In addition, the study showed that black and Hispanic patients especially showed a great adherence benefit from mail-order pharmacies.

Co-pays that were ≤$10 for a 30 days’ supply and annual individual out-of-pocket maximums that were ≤$2000 were also associated with higher adherence.

By optimizing these 4 variables, good medication adherence prediction percentages were shown to nearly double when compared with health-system-level factors that were less optimized, including a <31-day supply of medication, a copay of >$10, out-of-pocket maximums of >$2000, and no mail-order pharmacy fills.

The predicted percentages of patients with the most optimized variables achieved roughly 90% adherence, while those with less optimized variables were predicted to have 50% adherence.

Adherence of roughly 90% exceeds what is necessary to achieve a CMS 5-star rating, the researchers noted.

“This suggests that multifactorial efforts to lower system-level barriers to obtaining medications can profoundly impact health plan Medicare star scores for CVD risk factor medication adherence,” the authors concluded.