SOP-led Study Shows Need for Greater Medication Adherence
Featured in the July issue of Health
Affairs, groundbreaking research led by Bruce Stuart, PhD, executive
director of the Peter Lamy
Center for Drug Therapy and Aging and professor in the Department
of Pharmaceutical Health Services Research (PHSR) at the University of Maryland
School of Pharmacy, suggests new approaches are needed to improve
medication adherence and reduce overall health care costs among
Medicare Part D beneficiaries.
"The goal of this study was to determine if the rules established by
the Centers for Medicare and Medicaid Services [CMS] to determine
beneficiaries' eligibility for medication therapy management [MTM] are
appropriate," says Stuart. "My colleagues and I wanted to gain a better
understanding about whether or not these rules were inclusive enough to
capture those patients who could gain the most from the interventions
associated with MTM."
Patients who participate in MTM services meet with a pharmacist to
review their medication regimen and receive counseling about the
importance of taking medications as prescribed. The Medicare
Prescription Drug, Improvement, and Modernization Act of 2003, which
established the Part D benefit, requires plans to offer MTM services to
beneficiaries with multiple chronic conditions, who are taking multiple
different medications, and have high annual drug spending.
"Medicare Part D prescription drug plans operate under strict
eligibility criteria," says Stuart. "Prescription drug plans are only
required to offer MTM services to those enrollees who have high annual
drug spending, a minimum of two or three chronic conditions, and who
are taking two to eight different Part D-covered drugs. As a result,
only a small percentage of beneficiaries qualify to receive these
Working with F. Ellen Loh,MBA,
PHSR graduate research assistant at the School of Pharmacy; Pamela
Roberto, senior director at Pharmaceutical Research and Manufacturers
of America (PhRMA); and Laura Miller, senior economist at the
National Association of Chain Drug Stores (NACDS), Stuart analyzed data
for patients with diabetes, heart failure, or chronic obstructive
pulmonary disease who were enrolled in the Medicare Part D prescription
drug program. The results showed that poor medication adherence was
associated with additional medical and hospital visits, which resulted
in additional costs for Medicare Part A and B services in the range of
$49 to $840 per beneficiary, per month.
Stuart and his colleagues also produced a new metric -- "potentially
preventable future costs" -- that can be used to target MTM
interventions to at-risk beneficiaries with the aim of both improving
the quality of care and reducing unnecessary Medicare costs.
"There are a substantial number of Medicare Part D enrollees with low
medication adherence whose health outcomes and costs could be improved
if they had access to MTM services," says Stuart. "We suggest that
patients' potential for improved outcomes and decreased health care
costs should be added as a criterion when determining their eligibility
for MTM services."
The publishing of the new research follows a significant action by the
Congressional Budget Office (CBO) in 2012, which estimated that an
increase in the number of prescriptions filled by Medicare
beneficiaries reduces spending on other medical services. The CBO will
now credit policies that increase use of medicines with savings on
other Medicare services.
"We still need a better understanding of the real impact of current MTM
interventions," says Stuart. "Currently, we do not have information
about actual MTM interventions and cannot be certain that these
services have a major impact on patients' medication adherence. We hope
to address this concern in future studies as new information about
these services is released."
|Posting Date: 07/09/2013
|Contact Name: Malissa Carroll
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