July 8, 2013
Findings show poor medication adherence costs an extra $49 to $840 per Medicare beneficiary, per month
Washington, DC – Amid mounting evidence of the negative clinical and economic consequences of medication non-adherence, research featured on the cover of this month’s Health Affairs breaks new ground by urging innovative approaches to improve medication adherence and to “achieve a higher-performing health system.”
The researchers analyzed data for patients with diabetes, heart failure, and chronic obstructive pulmonary disease who were enrolled in the Medicare Part D prescription drug program. Of the notable findings, the report showed that poor medication adherence was associated with additional medical and hospital visits resulting in otherwise avoidable spending for Medicare Part A and B services in the range of $49 to $840 per beneficiary per month.
In addition to gauging potential Medicare cost-savings by improving medication adherence, the study evaluated the criteria by which Medicare Part D beneficiaries are deemed eligible for medication therapy management (MTM) – a program in which a pharmacist or other qualified health professional reviews a patient’s medication regimen and helps to optimize outcomes through improved medication use.
“By combining the two methods, we produce a new metric, ‘potentially preventable future costs,’ that can be used to target medication therapy management interventions to at-risk beneficiaries with the aim of both improving the quality of care and reducing unnecessary Medicare expenditures,” the researchers wrote.
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. Under current eligibility criteria however, only a small share of beneficiaries qualify to receive these services.
“We believe that potential costs averted should be considered as a criterion for targeting [MTM] interventions and that attention therefore should be given to beneficiaries now excluded from review who display suboptimal adherence patterns associated with the highest Medicare costs,” the researchers wrote.
They urged that improving medication adherence “offers one of those rare opportunities in health care to achieve multiple desirable endpoints from the same policy.”
The publishing of the new research follows a significant action by the Congressional Budget Office (CBO), which evaluates the financial implications of proposed legislation. In 2012, CBO estimated that an increase in the number of prescriptions filled by Medicare beneficiaries “offsets” or reduces spending on other medical services. As a result, CBO will now credit policies that increase use of medicines with savings on other Medicare services.
The article was authored by Bruce Stuart, professor in the Department of Pharmaceutical Health Services Research and director of the Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy; F. Ellen Loh, graduate research assistant at the University; Pamela Roberto, senior director, Pharmaceutical Research and Manufacturers of America (PhRMA); and Laura M. Miller, senior economist, National Association of Chain Drug Stores (NACDS).