title: The Influence of a Community Pharmacy Automatic Prescription Refill Program on Medicare Part D Adherence Metrics.
abstract: BACKGROUND
  The Centers for Medicare & Medicaid Services (CMS) include measures of medication adherence within its Medicare Part D star ratings program. These adherence measures have motivated the development of new methods to improve patient adherence. Automatic prescription refill programs in community pharmacies are an intervention that has seen widespread adoption in recent years. These automatic refill programs anticipate and initiate prescription refills on a standardized, recurrent basis. As a result, prescription refills may be filled before a patient typically might initiate a refill. This study measures the effect of an automatic prescription refill program on 3 adherence metrics used by CMS within Medicare Part D star ratings.
  
  
  OBJECTIVE
  To compare the value of Medicare Part D adherence metrics for an automatic prescription refill program relative to standard prescription refills.
  
  
  METHODS
  Prescription dispensing data (January 1, 2014-December 31, 2014) from a chain of 29 pharmacies in a midwestern state were used to conduct this analysis. A post-only, quasi-experimental design separated patients into automatic and standard prescription refill cohorts. Refill adherence was calculated using proportion of days covered (PDC) for each of the 3 adherence metrics used by CMS for statins, renin angiotensin aldosterone system antagonists (RASA), and noninsulin diabetes medications. The adherence rate was defined as the proportion of patients with a PDC ± 80%. Inclusion criteria for patients followed the Pharmacy Quality Alliance technical specifications. Chi-square analysis and multiple logistic regression were used to examine differences in PDC > 80% between the 2 study cohorts.
  
  
  RESULTS
  There were 1,018, 1,006, and 368 patients for the automatic refill cohort and 3,928, 3,409, and 1,207 patients for the standard refill cohort in the statin, RASA, and diabetes adherence metrics, respectively. The mean age [SD] of patients was between 79.2 [±8.5] and 80.8 [±9.9] years across all cohorts. Patients in the automatic prescription refill program tended to take less than 1 additional chronic medication compared with the standard refill prescription cohort. The proportion of adherent patients ranged from 73.6% to 76.4% for standard refill cohorts and 77.5% to 83.6% for automatic refill cohorts. Differences between study cohorts were statistically significant for all the adherence metrics based on the chi-square test (P < 0.05). Patients enrolled in the automatic prescription refill program were more likely to be adherent to the statin (OR = 1.51, 95% CI = 1.26-1.82), RASA (OR = 1.20, 95% CI = 1.01-1.42), and diabetes (OR = 1.44, 95% CI = 1.06-1.96) metrics.
  
  
  CONCLUSIONS
  Patients enrolled in the automatic prescription refill program were more likely to be adherent to their medications. Enrollment in automatic prescription refill programs could be encouraged by health plans and pharmacists because of their potential effect on Medicare Part D star ratings.
  
  
  BACKGROUND
  The project described was supported by the Clinical and Translational Science Award (CTSA) program through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Lester is employed as a pharmacist in the participating pharmacy chain. The authors report no other relevant conflict of interest. Study concept and design were primarily contributed by Lester, with assistance from the other authors. Lester took the lead in data collection, along with Chui, and data interpretation was performed by Lester, Mott, and Chui. The manuscript was written primarily by Lester, along with Mott, and revised by Lester, Mott, and Chui.
authors.affiliation: 1 Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison.
authors.forename: Corey A
authors.initials: CA
authors.lastname: Lester
authors.affiliation: 1 Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison.
authors.forename: David A
authors.initials: DA
authors.lastname: Mott
authors.affiliation: 1 Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Chui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003157:Community Pharmacy Services / Q000592:standards* / Q000639:trends; D011307:Drug Prescriptions / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D054524:Medicare Part D / Q000592:standards* / Q000639:trends; D055118:Medication Adherence; D054539:Medication Therapy Management / Q000592:standards* / Q000639:trends; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology