Home Delivery: Better Adherence for Medicare

Apr 3, 2014
Medicare Part D patients with diabetes, hypertension and high cholesterol, who use a home delivery pharmacy, were 59% more likely to be adherent.
  • Medicare
  • Seniors

According to new Express Scripts research presented today at the Academy of Managed Care Pharmacy 26th Annual Meeting, Medicare Part D patients taking medications for the comorbid conditions of diabetes, hypertension and high cholesterol who used a home delivery pharmacy were more than 1.5 times (59%) more likely to be adherent with their prescription drug treatment regimen than patients who filled their prescriptions at a retail pharmacy.

This study is the latest in a series of research studies that demonstrate home delivery pharmacies play a vital role in ensuring healthier patient outcomes by improving medication adherence.

These findings are especially important when you consider that two-thirds of Medicare beneficiaries have at least two or more chronic conditions accounting for more than 90% of Medicare healthcare spend. Diabetes, hypertension and high cholesterol represent three of the top five most prevalent conditions among Medicare beneficiaries, making adherence to prescription therapy integral to improved health outcomes and reduced healthcare spending.

Click to view the full study.

About the Study

The Express Scripts research team examined pharmacy claims for 40,632 patients enrolled in a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan from October 2010 to December 2012. Patients in this study were 65 years and older, were continuously eligible for Medicare coverage and had prescription drug claims for an antidiabetic, an antihypertensive and an antihyperlipidemic medication over the two-year period.

The analysis addressed a variety of concerns about the design of past studies, such as differences in predisposition of patients to be adherent, demographics, low-income subsidy status, days’ supply, disease burden and drug-use pattern. We also excluded patients enrolled in home delivery auto-refill programs to reduce potential bias.

We measured adherence using proportion of days covered (PDC), which tells us the number of days a patient has medication on hand during the study period. A delay in refilling could indicate nonadherence to the medication regimen. To be considered adherent, patients needed a PDC of at least 80% for all three conditions. Patients with a PDC less than 80% for one or more of the three medication classes were classified as nonadherent.

In addition, patients were assigned a primary dispensing channel depending on where they filled the majority (at least 66.7%) of their prescriptions for medications used to treat diabetes, hypertension and high cholesterol. The rest were assigned to a mixed group. On average, home delivery had 23% more adherent patients than the retail group, and 19% more adherent patients than the mixed group.

Adherence in the mixed channel group is lower as many of those patients tend to have less stability in their therapy regimen as doctors try different medications and dosages to achieve optimal outcomes for their patients.

Impact of Adherence on Medicare Part D

In addition to the improved health outcomes that result from better medication adherence, the findings of this study have important financial implications for Medicare Part D plans. Better adherence can improve a plan’s Star Quality Rating, an important consideration for consumers when choosing a health plan, and for managed care plans as higher star ratings may result in greater reimbursement from CMS.

Consumers and managed care stakeholders looking for improved quality, reduced costs and better health outcomes should consider the use of home delivery pharmacy.

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