Treatment Adherence Improves Paid Pharmacy Claims in Patients with Diabetes, Hypertension

Adherence to medications for diabetes, hypertension, and hyperlipidemia are triple-weighted metrics that can significantly impact Centers for Medicare & Medicaid Services’ Medicare Advantage Plan (MAP) Quality Bonus Payments. However, a specific tool that improves medication adherence does not exist.

The Medication Adherence Tracker (MAT) is an innovative initiative to address this issue that holds primary care physicians (PCPs) accountable for interventions that can result in paid pharmacy claims. Researchers used MAT and examined whether this intervention is more likely to result in paid pharmacy claims. The results of the study were presented at the AMCP Annual Meeting during a poster session titled “Evaluating the Impact of Primary Care Physician Intervention on Paid Pharmacy Claims Using a Medication Adherence Tracker in a Medicare Advantage Plan.”

This retrospective analysis used data from MAP beneficiaries in South Texas who were included in the MAT initiative between June and December 2016. The researchers generated a pharmacy report for each PCP biweekly, which identified high-risk, nonadherent patients based on their estimated year-to-date proportion of days covered rate of <0.8.

Each cycle a health plan pharmacist prepared the report, and embedded health plan nurses delivered the reports to their assigned PCPs. After approximately three weeks, the PCPs reported the number of interventions to the health plan nurse, who documented them in the MAT spreadsheet.

A total of 3,539 patients were included: 74.7% received the PCP intervention and 25.3% did not.

Patients who received the PCP intervention were 20 times more likely to have a paid pharmacy claim than those who did not (odds ratio [OR], 20.6; 95% CI, 15.9-26.7). Patients who received the PCP intervention were three times more likely to be adherent to treatment at the end of the year than those who did not (OR, 3.1; 95% CI, 2.6-3.7).

“Our study suggests the MAT is useful for improving rates of paid pharmacy claims and adherence overall,” the researchers concluded.

Hong M, Esse T, Vadhariya A, Gallardo E, Serna O, Abughosh S. Evaluating the Impact of Primary Care Physician Intervention on Paid Pharmacy Claims Using a Medication Adherence Tracker in a Medicare Advantage Plan. Abstract U16. Presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting, April 23-26; Boston, MA.