The ABCs Of Cardiovascular disease And Stroke Prevention: Pharmacist And payer perspectives on service povision and payment

Abstract

Objective: This study aimed to ex-amine trends of medication adherence to hypertension, cholesterol, and oral dia-betes drugs among medication therapy management (MTM) beneficiaries from two Medicare Part D plans. Methods: All Medicare Part D beneficiaries from the two drug plans were eligible for an MTM program. Four 6-month periods during 2010 to 2012 were used to assess the adherence trend, using proportion of days cov-ered (PDCs). PDC was calculated using guidelines given by Pharmacy Quality Alliance. For each of four drug classes, a cohort of Medicare Part D beneficiaries from each plan aged 65 years or older with at least two dispensed prescriptions of that drug class in a study period were identified as the study sample. The num-bers of patients in the drug classes were: β-blockers (n = 14,832), oral diabetes medications (n = 5,757), angiotensin-con-verting enzyme inhibitors/angiotensin receptor blockers (n = 17,991), and statins (n = 17,515). All prescription claims with a fill date within each 6-month study pe-riod were extracted for analyses. Gener-alized estimating equations estimated the time effect associated with the like-lihood of a desirable medication adher-ence (defined as PDC >0.8) for each drug class. Results: The mean of PDC was >0.9 within each study period across every drug class. The proportion of patients with desirable medication adherence in-creased over time, across four targeted drug classes. After adjusting for ben-eficiaries' age, gender, and type of drug plan, the time effects remained (P <0.01). However, the association between time and likelihood of desirable medication adherence differed by drug type and gender. Conclusion: The overall medication adherence to hypertension, cholesterol, and oral diabetes drugs among ben-eficiaries in two Medicare drug plans increased from 2010 to 2012. It is possible that inclusion of adherence measures in Medicare quality (star) ratings and the MTM program that engaged ben-eficiaries through targeted medication reviews may be reasons for this improve-ment. Objective: This study evaluated the impact of a pharmacist-initiated, en-hanced medication letter intervention within a retrospective drug utilization review program. The primary objective of the initiative was to address drug-related problems (DRPs) within a New York State Medicaid fee-for-service pop-ulation that were not identified by auto-mated vendor reports. Methods: This was a quasi-exper-imental study of patient profiles from February 2011 to July 2012. DRPs not identified by the vendor were reviewed by clinical pharmacists and possible in-terventions included coordination of care (CoC), medication adherence (MA), and therapeutic appropriateness (TA). Enhanced letters were mailed to pre-scribers monthly during the study pe-riod detailing the DRP with a survey to evaluate utility of the letter. Medication profiles were assessed 3 months before and after intervention to determine letter success. Success was defined as addition