title: Initial Medication Adherence in the Elderly Using PACE Claim Reversals: A Pilot Study.
abstract: BACKGROUND
  The Medicare Modernization Act, with its requirements for Medicare Part D to comply with electronic prescribing (e-prescribing), bolstered the adoption of e-prescribing, which increased to 73% in 2013. Therefore, understanding whether electronic prescriptions are less likely to be picked up is important as e-prescribing continues to be emphasized.
  
  
  OBJECTIVE
  To assess whether prescription origin is among the factors associated with initial medication adherence, using claim reversals as a proxy measure.
  
  
  METHODS
  A cross-sectional study was completed using a sample of reversed claims from the Pharmaceutical Assistance Contract for the Elderly (PACE) program for September 2014. The total number of reversed claims for new prescriptions (15,966) was categorized by prescription origin (written, telephone, electronic, fax, and pharmacy). Using a chi-square analysis, the reversed claims were compared among prescription origin to determine if there is a difference in the proportion of electronic prescriptions reversed compared with those from other origins.
  
  
  RESULTS
  When compared with all other prescription origins, electronic prescriptions (E) were more likely to be reversed at day 0 (E = 50%, any other [AO] = 49%, P < 0.05) and after day 0 (E = 58%, AO = 42%, P < 0.05).
  
  
  CONCLUSIONS
  Electronic prescriptions are associated with a higher rate of claim reversals and may reflect poorer initial adherence. Electronic prescriptions may more likely be forgotten or not picked up because they were not presented to the pharmacy by the patient. The growing adoption of electronic prescriptions merits particular attention, since it may be a factor in initial medication adherence in the elderly.
  
  
  BACKGROUND
  This study was not supported by any funding. Peterson reports advisory board and consultancy fees from IMS Health and Pfizer and employment by Genentech. Klaiman is currently employed by AccessMatters. No other financial or other conflicts of interests were reported. Study concept and design were primarily contributed by Forestal, along with Klaiman and Peterson. Heller took the lead in data collection, along with Forestal, and data interpretation was performed by Forestal, Klaiman, and Peterson. Forestal, Klaiman, and Heller were responsible for manuscript preparation.
authors: 1 University of the Sciences in Philadelphia, Philadelphia, Pennsylvania.
authors: Doris A
authors: DA
authors: Forestal
authors: 1 University of the Sciences in Philadelphia, Philadelphia, Pennsylvania.
authors: Tamar A
authors: TA
authors: Klaiman
authors: 1 University of the Sciences in Philadelphia, Philadelphia, Pennsylvania.
authors: Andrew M
authors: AM
authors: Peterson
authors: 2 Magellan Medicaid Administration/PACE, Harrisburg, Pennsylvania.
authors: Debra A
authors: DA
authors: Heller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D055695:Electronic Prescribing / Q000191:economics*; D005260:Female; D006801:Humans; D007345:Insurance Claim Review / Q000191:economics* / Q000639:trends; D008297:Male; D055118:Medication Adherence; D010414:Pennsylvania / Q000453:epidemiology; D010865:Pilot Projects