Impact of a pharmacy care management service on cardiometabolic medication adherence and resource use for Medicare Advantage beneficiaries

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BACKGROUND: Prescribing rates and adherence to evidence-based cardiometabolic medications remain suboptimal. Many strategies to improve prescribing and adherence have been developed, among which pharmacy care management (PCM) programs are among the most consistently effective. Data on PCM programs come from studies that developed interventions specifically for research purposes. Benefits of real-world PCM programs for patients with cardiometabolic conditions are incompletely understood. OBJECTIVE: To evaluate the effect of an existing PCM program in individuals with cardiometabolic conditions, specifically, whether the program improved adherence to cardiometabolic medications and reduced all-cause and cardiometabolic-specific health care use and whether those nonadherent at baseline would benefit most. METHODS: We conducted a retrospective cohort study using adjudicated administrative claims data from a large regional Medicare Advantage Prescription Drug health plan. A total of 27,910 beneficiaries were identified as potentially eligible for the PCM program between December 2019 and November 2021. The cohort was restricted to individuals who filled at least 2 prescriptions for a cardiometabolic condition, filled at least 1 prescription after PCM enrollment, and were continuously eligible for health plan benefits for at least 12 months before and after enrollment. Potential controls met the same criteria but did not participate in the PCM program and filled prescriptions at non-PCM pharmacies. Control and PCM patients were matched 5:1 using direct and propensity score matching. The primary outcome was all-cause hospitalization over 12 months. Secondary outcomes included cardiometabolic medication adherence and disease-specific hospitalizations. We further evaluated program effects on rates of disease-specific hospitalization in patients nonadherent vs adherent at baseline. RESULTS: = 0.286). CONCLUSIONS: Compared with well-matched controls, PCM patients with cardiometabolic disease had significantly higher rates of medication adherence and significantly lower hospitalization rates during the 12-month follow-up period. This effect was greatest in patients nonadherent at baseline. Our results provide insights into how PCM programs achieve their benefits and underscore the value of targeting the PCM program to high-risk individuals.

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