title: Impact of provider mailings on medication adherence by Medicare Part D members.
abstract: BACKGROUND
  The Medicare 5-Star Rating System measures and provides incentive for improving Medicare Part D plans through a quality-based payment program. Adherence to medications for chronic conditions is key to the Star ratings. Our objective was to assess the impact of direct-to-provider letters on improving medication adherence.
  
  
  METHODS
  Members of a large US pharmacy benefits manager (PBM) who did not adhere to prescription of oral diabetes (antidiabetics), cholesterol-reducing (statins), or hypertension (renin angiotensin system [RAS] antagonists) drug therapy were identified from the prescriptions claims data of>600,000 continuously enrolled Medicare members. Nonadherence was defined by the Star ratings definition of proportion of days covered (PDC)<80%. The PBM sent letters to prescribing physicians of nonadherent members, requesting that they discuss adherence barriers and potential solutions with their patients. A historical control cohort was constructed from the PBM satisfying the same eligibility criteria as the intervention cohort. Both binary (≥80%) and continuous PDC measures were assessed as outcomes through multivariate logistic regression and difference-in-difference models, respectively.
  
  
  RESULTS
  Final sample sizes were 21,044; 106,829; and 73,560 patients for antidiabetic, statin, and RAS antagonist use, respectively, with approximately equal number of intervention and control subjects in each drug class. Physician mailing was associated with 11%, 16%, and 7% higher odds of being adherent by members in antidiabetic, statin, and RAS antagonist cohorts, respectively (all P<.001).
  
  
  CONCLUSIONS
  Within limitations of historical controls, physician mailing was associated with improved medication adherence.
  
  
  CONCLUSIONS
  Physician mailing can be an impactful tool for improving medication adherence.
  
  
  METHODS
  II.
authors.affiliation: Division of Health Care Policy and Research, Department of Health Sciences Research & Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States. Electronic address: borah.bijan@mayo.edu.
authors.forename: Bijan J
authors.initials: BJ
authors.lastname: Borah
authors.affiliation: Prime Therapeutics LLC, Eagan, MN, United States.
authors.forename: Yang
authors.initials: Y
authors.lastname: Qiu
authors.affiliation: Division of Health Care Policy and Research, Department of Health Sciences Research & Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.affiliation: Prime Therapeutics LLC, Eagan, MN, United States; University of Minnesota College of Pharmacy, Minneapolis, MN, United States.
authors.forename: Patrick P
authors.initials: PP
authors.lastname: Gleason
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D054524:Medicare Part D / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D010593:Pharmaceutical Services / Q000592:standards*; D011177:Postal Service / Q000706:statistics & numerical data*; D055553:Prescription Drugs / Q000191:economics*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States; D016903:Drug Monitoring
chemical_list: D055553:Prescription Drugs
keywords: Medicare Part D prescription plan; Medicare Star Rating System; Medication adherence; Prescriber mailing; Proportion of days covered