Policy Documents

Increasing Medicare Part D Enrollment In Medication Therapy Management Could Improve Health And Lower Costs

Bruce Stuart, F. Ellen Loh, Pamela Roberto, and Laura M. Miller –
July 9, 2013

In this update, the authors contend that 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.

The authors 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.

 


Bruce Stuart (bstuart@rx.umaryland.edu) is a professor in the Department of Pharmaceutical Health Services Research, University of Maryland Baltimore.

Ellen Loh is a graduate research assistant in the Department of Pharmaceutical Health Services Research, University of Maryland Baltimore.

Pamela Roberto is senior director at Pharmaceutical Research and Manufacturers of America (PhRMA), in Washington, D.C.

Laura M. Miller is a senior economist at the National Association of Chain Drug Stores, in Alexandria, Virginia.