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Two Prime Therapeutics Programs Associated with Improved Adherence for Medicare Members Using Cholesterol, Diabetes and Hypertension Drugs
Lower generic cost share, missed refill interventions may yield better health, higher Star Ratings

ST. PAUL, Minn., May 16, 2018 /PRNewswire/ -- Prime Therapeutics LLC (Prime), a pharmacy benefit manager serving more than 27 million members nationwide, found lowering a member's cost share for generic medicines and intervening after a missed medication refill were associated with an improvement in medication adherence for Medicare members. This is important because adherence to medication can improve health outcomes and reduce health care costs.1 The Centers for Medicare and Medicaid Services (CMS) include medication adherence in their measurement of a health plan's quality known as "Star Ratings." The higher the adherence of members to medication, the higher the health plan's Star Rating.

In the first study, Prime reduced the member cost share for generic hypertension, cholesterol and diabetes drugs in Prime's Stars formulary benefit program, from $4 or more to $0-$2 per 30-day supply. The study identified an average of 160,000 Medicare members as eligible for this intervention each month.

The results showed members with the lowered cost share saw improved adherence of 1.4 percentage points overall, compared to members not in the program. Adherence improved 1.5 percentage points for cholesterol drugs, 1.4 percentage points for hypertension drugs – both statistically significant improvements – and 1.4 percentage points for diabetes drugs. These changes are meaningful because the difference in a 3-Star rating to 4-Star rating is often only 3 to 4 percentage points.

The second study analyzed Prime's Missed Refill program – a Medicare member outreach program designed to decrease members' drug supply gaps and increase adherence for the same three drug categories: cholesterol, hypertension and diabetes. Nearly 83,000 Medicare members were identified to have up to a seven-day gap in medication supply. Three to five days after identification, members received a call reminding them to refill their medication. Members received a reminder letter if a medication claim was not processed within 10 days.

Medication refills increased 1.5 percentage points and showed an 8 percent higher refill rate among members who received the intervention compared to those who did not. Medication refills improved 1.4 percentage points for cholesterol drugs, 1.7 percentage points for hypertension drugs and 1.9 percentage points for diabetes drugs – all statistically significant improvements. The frequency of refills spiked following the call, while the member letter generated a slightly smaller spike.

"It is important that our members stay adherent to their prescribed medicines because it improves their overall health. Separately, greater adherence can improve a health plan's Star Ratings," said Patrick Gleason, PharmD, senior director of health outcomes at Prime. "These study results can drive better understanding of adherence drop-off points and is helping us develop and improve programs that support our members to take medicines as directed."

This year, Prime launched a new program to increase medication adherence of Medicare members. GuidedHealth® Care–Smart Adherence leverages the Missed Refill program in addition to using Prime's predictive modeling tools to identify Medicare members at risk for non-adherence in the three main drug categories identified by CMS. Prime pharmacists can then outreach to the members most at-risk to assist with minimizing barriers and help improve likelihood of adherence.

Prime will present the results of these two studies at the Pharmacy Quality Alliance (PQA) Annual Meeting May 16-18 in Baltimore. Research abstracts are available in the current issue of Research in Social and Administrative Pharmacy (RSAP).

1.     Iuga, A, McGuire, M. Adherence and health care costs. Risk Management and Health Policy. 2014; 7:35-44.

About Prime Therapeutics
Prime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. Prime manages pharmacy benefits for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and offers clinical services for people with complex medical conditions. Prime serves more than 27 million people. It is collectively owned by 18 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. For more information, visit www.primetherapeutics.com or follow @Prime_PBM on Twitter.

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SOURCE Prime Therapeutics