Effects of the Medicare Part D comprehensive medication review on medication adherence among patients with Alzheimer’s disease

Abstract

Objective

Older patients with Alzheimer’s disease (AD) are challenged with adhering to complex medication regimens. We examined effects of Comprehensive Medication Review (CMR), a required Medicare Part D Medication Therapy Management (MTM) program component, on medication adherence among AD patients.

Methods

This retrospective study analyzed 100% of 2016–2017 Medicare claims covering the entire United States, linked to Area Health Resources Files. Medicare beneficiaries aged ≥65 years were included. Propensity score matching identified comparable intervention and comparison groups with the intervention defined as receiving a CMR in 2017. A difference-in-differences analysis included in multivariate logistic regressions an interaction term between CMR receipt and year 2017. The outcome measured was nonadherence to diabetes, hypertension and hyperlipidemia medications, with nonadherence defined as proportion of days covered <80% for study medications.

Results

Unadjusted comparisons indicated the proportion of nonadherence for intervention group members decreased from 2016 to 2017 but increased for the comparison group. In adjusted analyses, reduction in medication nonadherence among the intervention group remained higher: odds ratios for the interaction term were 0.62 (95% confidence interval [CI] = 0.54–0.71), 0.54 (95% CI = 0.50–0.58) and 0.50 (95% CI = 0.47–0.53) respectively for diabetes, hypertension and hyperlipidemia medications. This suggests that the likelihood of nonadherence in the intervention group was respectively reduced by 38%, 46% and 50% more than the comparison group.

Conclusions

CMR was found to reduce nonadherence to diabetes, hypertension and hyperlipidemia medications among older Medicare beneficiaries with AD. This provides evidence that the MTM program is effective for a population with unique medication compliance challenges.

Keywords:

• Medicare
• medication therapy management
• comprehensive medication review
• adherence
• Alzheimer’s

Transparency

Declaration of funding

Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG040146. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author contributions: X.D.: concept and design, analysis and interpretation of data, and writing (original draft and editing). C.C.S.T.: concept and design, analysis and interpretation of data, and writing (original draft and editing). S.Z.: concept and design, analysis and interpretation of data, and writing (original draft and editing). J.A.B.: concept and design, analysis and interpretation of data, and writing (original draft and editing). J.Y.W.: funding acquisition, concept and design, analysis and interpretation of data, and writing (original draft and editing). M.A.C.-B.: funding acquisition, concept and design, analysis and interpretation of data, and writing (original draft and editing). C.K.F.: concept and design, analysis and interpretation of data, and writing (original draft and editing). J.W.T.: funding acquisition, concept and design, analysis and interpretation of data, and writing (original draft and editing). L.E.H.: concept and design, analysis and interpretation of data, and writing (original draft and editing). J.W.: funding acquisition, concept and design, analysis and interpretation of data, writing (original draft and editing), and project administration.

Declaration of financial/other relationships

M.A.C.-B. has disclosed that she has received funding from the Carlos and Marguerite Mason Trust. J.W. has disclosed that she has received funding from AbbVie, Curo, Bristol Myers Squibb, Pfizer, and Pharmaceutical Research and Manufacturers of America (PhRMA); and serves on the Health Outcomes Research Advisor Committee of the PhRMA Foundation. No potential conflict of interest was reported by X.D., C.C.S.T., S.Z., J.A.B., J.Y.W., C.K.F., J.W.T. or L.E.H. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

Data availability statement: The Medicare data were accessed through virtual access to the CMS Virtual Research Data Center.