Lower total cost of care, hospitalizations, emergency visits associated with greater drug adherence among Medicare Advantage members

EAGAN, Minn. – Poor medication adherence (taking as prescribed) is associated with increased hospitalization risk, worse health care outcomes and increased overall health care costs.¹’² New research from Prime Therapeutics LLC (Prime) found a financial savings of $21-$46 per one percentage point improvement in medication adherence per patient per year (PPPY) depending on drug category.

The Centers for Medicare and Medicaid Services (CMS) has three medication adherence quality performance measure categories known as Medicare Star Ratings. The medication categories are: hypertension (renin angiotensin system [RAS] antagonists), cholesterol lowering (statins) and diabetes (excluding insulin). These three categories make up 11% of the overall Medicare Advantage Star score.³ Having more members who take medicines as prescribed helps increase a health plan’s Star Rating. Higher Star Ratings help plans increase plan enrollment and achieve CMS incentive payments for quality performance.

With a Medicare Advantage study population of over 567,000, sample sizes for each drug category and their associated total cost of care savings – from moving someone with low adherence (<50%) to near perfect adherence (99%+) – was as follows:

• RAS: 132,358 in the sample, achieving $2,901 potential savings PPPY
• Statin: 145,038 in the sample, achieving $1,563 potential savings PPPY
• Diabetes: 40,407 in the sample, achieving $3,365 potential savings PPPY

Additionally, the study found lower odds of hospitalizations and emergency room visits were associated with improved drug category adherence.

“This is another example of how access to integrated medical and pharmacy claims data can provide a comprehensive, real-world medication value view,” said Patrick Gleason, PharmD, assistant vice president of health outcomes at Prime. “This information is essential for our health plan clients and their members as it quantifies medication adherence value.”

Prime offers several solutions to help improve adherence. A 2019 Prime study assessed proactive reminder phone calls from a managed care pharmacist to members. Prime’s model predicted which members would benefit from reminders to improve use for RAS, statin and diabetes medicines.

This silver award-winning research will be presented at the Academy of Managed Care Pharmacy (AMCP) Nexus 2020 Virtual event Oct. 19-23.

1. Sokol MC, et al. Impact of medication adherence on hospitalization risk and healthcare cost. Medical Care. 2005;43:521–530.
2. Roebuck MC, et al. Medication adherence leads to lower health care use and costs despite increased drug spending. Health Affairs. 2011;30:91–99.
3. Medicare 2020 Part C & D Star Ratings Technical Notes – CMS. Pages 75-81; 125-129.