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Four Keys to Improving Medication Adherence Among the Diabetic Elderly

Greater supply, mail order pharmacy use, lower copays, lower out-of-pocket expense shown effective….

The Center for Medicare and Medicaid Services (CMS) uses a STAR program to monitor the quality of care in Medicare Advantage health plans. Researchers from Kaiser Permanente examined the relationship between those STAR medication adherence metrics and modifiable characteristics in the health system within the Medicare-aged diabetics population.

Using the Surveillance, Prevention, and Management of Diabetes Mellitus (SUPREME-DM) Datalink, the authors drew data from three Kaiser Permanente sites. Patients were included if they had diabetes in 2010 and were 65+ y.o. Medication adherence was defined as having a Portion of Days Covered (PDC) greater than or equal to 0.8, that is patients are adherent if they had enough medication on hand for 80% of the year. Health System-level characteristics include: mean days’ supply of medication, annual out-of-pocket max cost, drug copayment, and percent of medication delivered through mail order pharmacy.

The results showed that STAR-defined medication adherence was achieved with median prescribed days’ supply >90 days; using mail order >50% of the time was independently associated with better adherence, and African American and Hispanic patients had an increase in positive association with mail order. Medication copay equal to or less than $10 for 30 days’ supply and less than or equal to $2000 out-of-pocket max cost showed better adherence. The results showed that the achievement of medication adherence in the three therapeutic groups was ~90% when all 4 health-system level characteristics were optimized, while medication adherence was ~50% when the characteristics were least optimized.

The authors concluded that a greater medication days’ supply and mail order pharmacy use, along with lower copays and out-of-pocket maximums were associated with better adherence, with the strongest predictor of medication adherence being a greater days’ supply of medication. The authors noted that limitations existed in their study. These limitations include testing subjects that were just diabetic patients, and not those with hypertension and/or hyperlipidemia. Also, since the study was done specifically with Kaiser Permanente patients, the results may not apply to other settings.

Practice Pearls:

  • 4 key variables were looked at for its relationship on medication adherence.
  • A greater days’ supply >90 days, using mail order >50% of the time, and lower copay and out-of-pocket expense was shown to improve medication adherence.
  • This study was only done on diabetic patients from 3 different Kaiser Permanente sites and the results may not apply to other settings or patients with different disease states.

Schmittdiel, JA. Health Care System-level Factors Associated With Performance on Medicare STAR Adherence Metrics in a Large, Integrated Delivery System. Medical Care. 2015; 53(4): 323-337.