Impact of provider mailings on medication adherence by Medicare Part D members

• Published in: Healthcare : the journal of delivery science and innovation Vol. 4; no. 3; pp. 207 - 216
• Main Authors: Borah, Bijan J., Qiu, Yang, Shah, Nilay D., Gleason, Patrick P.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.09.2016
• Subjects: Aged; Aged, 80 and over; Chronic Disease - therapy; Databases, Factual; Female; Humans; Internal Medicine; Logistic Models; Male; Medicare Part D - statistics & numerical data; Medicare Part D prescription plan; Medicare Star Rating System; Medication adherence; Medication Adherence - statistics & numerical data; Multivariate Analysis; Pharmaceutical Services - standards; Postal Service - utilization; Prescriber mailing; Prescription Drugs - economics; Proportion of days covered; Retrospective Studies; Socioeconomic Factors; United States; Medication adherence; OR; PRG; RAS; CMS; Medicare Part D prescription plan; QDID; PDC; Prescriber mailing; Proportion of days covered; PBM; PDP; DID; Medicare Star Rating System; difference-in-difference; pharmacy benefits manager; Part D plan; pharmacy risk group; odds ratio; renin angiotensin system; proportion of days covered; quantile difference-in-difference; Centers for Medicaid and Medicare Services
• ISSN: 2213-0764; 2213-0772
• DOI: 10.1016/j.hjdsi.2016.02.004

The Medicare 5-Star Rating System measures and provides incentive for improving Medicare Part D plans through a quality-based payment program. Adherence to medications for chronic conditions is key to the Star ratings. Our objective was to assess the impact of direct-to-provider letters on improving medication adherence. Members of a large US pharmacy benefits manager (PBM) who did not adhere to prescription of oral diabetes (antidiabetics), cholesterol-reducing (statins), or hypertension (renin angiotensin system [RAS] antagonists) drug therapy were identified from the prescriptions claims data of>600,000 continuously enrolled Medicare members. Nonadherence was defined by the Star ratings definition of proportion of days covered (PDC)<80%. The PBM sent letters to prescribing physicians of nonadherent members, requesting that they discuss adherence barriers and potential solutions with their patients. A historical control cohort was constructed from the PBM satisfying the same eligibility criteria as the intervention cohort. Both binary (≥80%) and continuous PDC measures were assessed as outcomes through multivariate logistic regression and difference-in-difference models, respectively. Final sample sizes were 21,044; 106,829; and 73,560 patients for antidiabetic, statin, and RAS antagonist use, respectively, with approximately equal number of intervention and control subjects in each drug class. Physician mailing was associated with 11%, 16%, and 7% higher odds of being adherent by members in antidiabetic, statin, and RAS antagonist cohorts, respectively (all P<.001). Within limitations of historical controls, physician mailing was associated with improved medication adherence. Physician mailing can be an impactful tool for improving medication adherence. II