title: Increasing Medicare part D enrollment in medication therapy management could improve health and lower costs.
abstract: Targeting efforts to improve medication adherence, especially among people with high health needs, can improve health and lower health care spending. To this end, Medicare requires that insurance plans that provide prescription drug (Part D) coverage offer specialized medication therapy management services to optimize medication use for enrollees with high drug costs, multiple chronic diseases, and multiple covered drugs. We analyzed a large random sample of Part D enrollees with diabetes, heart failure, and chronic obstructive pulmonary disease, to see whether poor adherence to recommended drugs was associated with higher Medicare costs. We found that beneficiaries with poor adherence had higher costs, ranging from $49 to $840 per month for patients with diabetes, for example. However, such beneficiaries were not uniformly more likely than others to be eligible for medication therapy management services. Aligning medication therapy management eligibility with a metric such as potentially preventable future costs holds promise for both improving the quality of care and reducing spending.
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD, USA. bstuart@rx.umaryland.edu
authors.forename: Bruce
authors.initials: B
authors.lastname: Stuart
authors.forename: F Ellen
authors.initials: FE
authors.lastname: Loh
authors.forename: Pamela
authors.initials: P
authors.lastname: Roberto
authors.forename: Laura M
authors.initials: LM
authors.lastname: Miller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017046:Cost Savings; D003365:Costs and Cost Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000188:drug therapy / Q000191:economics; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data*; D054524:Medicare Part D / Q000191:economics* / Q000706:statistics & numerical data*; D055118:Medication Adherence; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011203:Poverty; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000191:economics; D014481:United States
keywords: Medicare Costs; Medication Adherence; Medication Therapy Management