May 3, 2018
Improving medication adherence saves lives and reduces the cost of healthcare, but about 50 percent of patients with chronic illness don’t take medications as prescribed.
How the ratings work
The Centers for Medicare & Medicaid Services’ (CMS) five-star quality rating system evaluates performance of Medicare Advantage (MA) plans across various metrics, including some HEDIS (National Committee on Quality Assurance) measures.
Premera monitors provider performance on these same measures and partners with providers to improve clinical care for our members, your patients.
The CMS rating system includes three triple-weighted, clinical pharmacy measures related to medication adherence for:
- Hypertension medication: angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB)
- Diabetes medication: oral (excludes insulin)
- Cholesterol medication: statins
These measures evaluate the percentage of your patients who fill their prescriptions to cover 80 percent or more of the time that they’re supposed to be taking the medication.
Why are patients non-adherent and what can you do?
| The patient forgets to refill the prescription on time or at all. |
Consider writing 90-day supplies of maintenance medications and have the patient use a mail order pharmacy. |
| The patient is unable to afford the medication or thinks the medication costs too much. |
If cost is a concern for a brand-name medication, consider switching to a lower-cost generic medication.
Reference Premera’s formulary for a lower tier drug and a lower cost drug that is just as efficacious. |
| The patient may not understand the importance of the medication or may think taking the medication will be harmful. |
Remember to emphasize the benefits of taking the medication and the negative consequences for not taking the medication. The benefits should outweigh the risk.
Remind the patient to let you know immediately if he or she experiences side effects. The patient should not stop or change the regimen without consulting you first. Reassure the patient that there are ways to manage side effects. |
| The patient has a difficult time remembering to take their medication. |
Offer the following suggestions:
- Use weekly or monthly pillboxes
- Install and use a smart phone app that has pill reminder alerts
- Place medications in a visible area (but in properly closed containers and safely out of reach of children or pets)
|
| The patient is unable to get to the pharmacy because of unreliable transportation. |
Inform the patient that many pharmacies offer delivery and strongly suggest mail order as their preferred option. |
As a clinician, your insight and expertise can help patients understand why they struggle with medication adherence and guide them to healthier outcomes.
Sources:
Mayo Clinic Proceedings, April 2011