M-01: Does Medication Therapy Management by Pharmacists Lower Cost-related Medication Nonadherence in Medicare Beneficiaries
Taylor Marie Walsh
South Carolina College of Pharmacy United States
Due to the increase of medication costs, many Americans experience cost-related nonadherence (CRN). This study will be the first to: 1) provide national estimates of the prevalence of CRN among MTM-eligible beneficiaries, and 2) assess the effects of MTM on CRN among Medicare beneficiaries.
We used a nationally representative study sample including Medicare Part D enrollees eligible for Meditation Therapy Management. Survey sampling weights were applied for national estimates of CRN. Weighted multivariable logistic regressions were conducted to investigate the effects of MTM on CRN.
The core components of MTM are medication therapy review, personal medication record, medication action plan, intervention and referral, and documentation and follow up. It is used by pharmacists to remove unnecessary drugs from the patient regimen, prevent adverse drug events and thus it is expected to reduce costs, and cost-related medication nonadherence. Medication therapy management may impact the Medicare population by reducing cost related nonadherence. However, a literature gap exists between the association between MTM services and the potential for CRN reduction. This research was conducted using a cross-sectional study design with Medicare Current Beneficiary Surveys (MCBS) from 2012. MCBS is a nationally representative sample of the Medicare population maintained by the Centers for Medicare and Medicaid Services (CMS).
The study identified 1,549 MTM-eligible beneficiaries. CRN measure was based on a response of “Yes” to any of the following questionnaires: “decide not to fill or refill a prescription because it was too expensive”, “skipped doses to make the medicine last longer”, “taken smaller doses of a medicine to make the medicine last longer” and “spent less money on food, heat or other basic needs so that you would have money for medicine”.
The prevalence of CRN was higher in MTM-eligible individuals than in non-MTM eligible individuals (24.14% vs. 13.44%; P < .0001). After controlling for covariates (age, gender, race, income, education, comorbidities, comorbidities, health status, low-income subsidy, and insurance coverage) using multi-variable logistic regressions, we found that MTM was significantly associated with CRN (OR: 1.59; 95% CI: 1.28-1.96). Other significant variables included fair or poor health status (OR: 1.72; 95% CI: 1.42-2.09) and without low-income subsidy (OR: 1.42; 95% CI: 1.10-1.83).
Medication therapy management (MTM) is provided by pharmacists as an approach for delivering nondispensing clinical pharmacy services to patients. Medicare Modernization Act of 2003 (Public Law 108-173) further expanded access to MTM services for Medicare Part D enrollees with prescription drug benefits.
Our study found that the prevalence of CRN among MTM-eligible individuals was higher in MTM group than the non-MTM group, and that MTM is associated with higher CRN. Although future studies with longitudinal design are warranted to further clarify the relationship between MTM and CRN. Our findings, however, are not surprising as patients who are eligible for MTM are those with a higher estimated annual medical cost.
To address this issue, CMS is initiating and testing a Medicare Part D Enhanced MTM Model with a five-year performance period that began January 1, 2017. The goal for this potential enhanced MTM model is to learn the best “right-size” for MTM services, to optimize medication use, to improve care coordination, and to strengthen health care system linkages. Our study suggests that identification of alternative strategies to improve low medication adherence due to high drug costs should be considered in future Medicare Part D Enhanced MTM Models for better medication management.