Impact of a Pharmacy Care Management Service on Cardiometabolic Medication Adherence and Resource Use for Medicare Advantage Beneficiaries
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BACKGROUND
Prescribing rates and adherence to evidence-based cardiometabolic medications remain suboptimal. Many strategies to improve prescribing and adherence have been developed; pharmacy care management (PCM) programs are among the most consistently effective of these. The clinical and economic benefits of ongoing PCM programs for patients with cardiometabolic conditions are incompletely understood.
OBJECTIVES
To evaluate the effect of a PCM program in individuals with cardiometabolic conditions, specifically, whether the program improved adherence to cardiometabolic medications and reduced all-cause and cardiometabolic-specific healthcare use, and whether those non-adherent at baseline would benefit most.
METHODS
We conducted a retrospective cohort study using adjudicated administrative claims data from a large regional Medicare Advantage Prescription Drug (MAPD) health plan. The PCM program was offered to MAPD beneficiaries who filled ≥ 8 chronic medications in the 180 days prior to eligibility screening. We restricted the cohort to individuals who filled ≥ 2 prescriptions for a cardiometabolic condition, filled at least one prescription after PCM enrollment, and were continuously eligible for health plan benefits for at least 12 months before and after enrollment. Potential controls were patients who met the same criteria but did not participate in the PCM program and filled prescriptions at non-PCM pharmacies. Control patients were matched to PCM patients in a 5:1 ratio using direct and propensity score matching. The primary outcome was all-cause hospitalization during the 12-month follow-up period. Secondary outcomes included cardiometabolic medication adherence and disease-specific hospitalizations. In pre-planned stratified analyses, we further evaluated the program effects on rates of disease-specific hospitalization in patients who were non-adherent versus adherent at baseline.
RESULTS
The final cohort consisted of 632 PCM patients and 3,160 well-matched controls. Compared to controls, PCM program participants had significantly higher rates of adherence to all classes of cardiometabolic medications, ranging from 4.7% (P = 0.028) for anticoagulants to 17.0% (P < 0.001) for beta-blockers. PCM program participation had 15% fewer all-cause hospitalizations per 1,000 patient months (P = 0.037) than matched controls. PCM patients experienced significantly fewer cardiometabolic-specific admissions (-33.7%; P = 0.025) and non-significant reductions in non-cardiometabolic admissions (-8.4%; P = 0.201). PCM patients who were non-adherent at baseline had a significant 39.1% reduction in cardiometabolic hospitalizations (P = 0.003) from baseline, while adherent patients had a non-significant 24.7% reduction (P = 0.286).
CONCLUSION
Compared with closely matched controls, PCM patients with pre-existing cardiometabolic disease had significantly higher rates of medication adherence and significantly lower hospitalization rates during the 12-month follow-up period. This effect was greatest in patients who were non-adherent at baseline. Our results provide insights into how PCM programs achieve their benefits and underscore the value of targeting the PCM program to high-risk individuals.
