Engaging Medicare members improves adherence, can lead to higher Star ratings

When members don’t take their medicine as prescribed, it can lead to increased hospitalizations and poor health outcomes. For Medicare plan sponsors, nonadherence drives up unnecessary health care costs. And the financial impact doesn’t end there.

Adherence measures account for 28 percent of a Prescription Drug Plan’s (PDP) Star ratings. Encouraging adherence and achieving a high Star rating are top priorities, and for good reason. In 2015, plans with ratings of less than four stars will lose out on an estimated $3.47 billion in bonus payments.1

What we studied

The Centers for Medicare and Medicaid Services requires PDP sponsors to provide Medication Therapy Management (MTM) programs to help optimize health outcomes. To learn how MTM programs impact adherence — and eventually Star ratings — our team of researchers analyzed pharmacy claims data for 1.2 million Medicare members. We compared adherence between qualified members who engaged in MTM* vs. those who did not within the three drug adherence Star ratings  categories: diabetes, statins and renin angiotensin system (RAS) antagonists).

What we learned

When analyzing the data, Prime found significant correlation with engagement in an MTM program and adherence. The proportion of adherent members who participated in MTM were:

  • 40 percent higher for oral diabetes medicine
  • 20 percent higher for statins
  • 20 percent higher for RAS antagonists

Why we did this study

Understanding how MTM impacts adherence is an important part of PDP sponsors’ Star ratings strategy. Our findings validate the importance of promoting MTM programs and making it easy for members to participate. Focusing on MTM engagement not only sets the stage for financial success — it helps ensure that members are getting the medicine they need to feel better and live well.

Learn more

Review the study poster, presented Oct. 26–29, 2015 at the Academy of Managed Care Pharmacy (AMCP) Nexus event in Orlando, Florida. >>

Read the press release.

*Defined as members who completed a comprehensive medication review vs. members who did not respond to multiple outreach attempts.

1. McKinsey Center for U.S. Health System Reform. (October 2014). Assessing the 2015 MA star ratings.

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Senior Health Outcomes Researcher

Cathy uses integrated medical and pharmacy data to study the impact of pharmacy programs and identify the most cost-effective treatments. Her research helps improve every aspect of pharmacy benefit management.