New Research Highlights “Rare Opportunity” to Improve Health Outcomes, Affordability through Targeted Medication Adherence Efforts
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).
The Health Affairs article abstract is available at the following web link: http://content.healthaffairs.org/content/32/7/1212.abstract
The University of Maryland (UM) School of Pharmacy, the fourth oldest school of pharmacy in the United States, leads pharmacy education, scientific discovery, patient care, and community engagement in the state of Maryland and beyond. With an enrollment of nearly 700 doctor of pharmacy and graduate students, the highly ranked school conducts cutting edge research in drug delivery mechanisms, cost impact studies, basic drug discovery and development, and disease management, and engages in a wide variety of professional practice activities, partnering with over 200 community pharmacies, hospitals, assisted living facilities, and other agencies to provide services to citizens and practitioners around the State and across the nation.
The Pharmaceutical Research and Manufacturers of America (PhRMA) represents the country’s leading innovative biopharmaceutical research and biotechnology companies, which are devoted to discovering and developing medicines that enable patients to live longer, healthier, and more productive lives. Since 2000, PhRMA member companies have invested approximately $550 billion in the search for new treatments and cures, including an estimated $48.5 billion in 2012 alone.
The National Association of Chain Drug Stores (NACDS) represents traditional drug stores, supermarkets, and mass merchants with pharmacies – from regional chains with four stores to national companies. Chains operate more than 41,000 pharmacies and employ more than 3.8 million employees, including 132,000 pharmacists. They fill over 2.7 billion prescriptions annually, which is more than 72 percent of annual prescriptions in the United States. The total economic impact of all retail stores with pharmacies transcends their over $1 trillion in annual sales. Every $1 spent in these stores creates a ripple effect of $1.81 in other industries, for a total economic impact of $1.81 trillion, equal to 12 percent of GDP. For more information about NACDS, visit www.nacds.org.
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