Improving medication adherence in the medicaid population through community pharmacist-provided services

Abstract

Background

The Pennsylvania Pharmacists Care Network established a payor program with a Medicaid Managed Care Organization (MCO) to provide adherence services to health plan members including medication synchronization, medication reconciliation, medication adherence packaging, and medication home delivery. These services are documented through the Pharmacist eCare Plan (PeCP); however, medication adherence metrics cannot be evaluated using PeCP data alone.

Objective

To evaluate medication adherence using both PeCP and claims data in patients who received community pharmacist-provided adherence services as part of a Medicaid MCO payor program.

Methods

Medication adherence was measured before and after the initiation of the payor program using proportion of days covered (PDC) for 3 targeted medication classes: renin angiotensin system antagonists (RASAs), HMG-CoA reductase inhibitors (statins), and noninsulin diabetic medications (NIDMs). Two-sided paired t-tests were used to compare the percentage of change in PDC values for each of the 3 target medication classes. An additional analysis was conducted for nonadherent patients, defined as those with PDC less than 80% during the baseline period. Regression analyses were used to assess if any factors impacted the likelihood of baseline nonadherent patients achieving a PDC above 80% during the intervention period.

Results

There were 1361 Medicaid patients that met inclusion criteria for the analyses. Average PDC across all 3 target drug classes increased significantly during the intervention period. Furthermore, average PDC significantly increased to at least 80% for all 3 drug classes in baseline nonadherent patients. Patients on RASAs or statins with baseline PDC <80% that received medication adherence packaging services were more likely to achieve a PDC of at least 80% during the intervention period.

Conclusion

This study demonstrates that community pharmacist-provided adherence services as part of a Medicaid MCO payor program positively impacted patient adherence as measured by PDC for RASAs, statins, and NIDMs.