Abstract
Background
Medication adherence is associated with improved health outcomes in multiple chronic diseases. Information is needed on the effectiveness of specific adherence interventions. This study’s objectives were to quantify effects of a targeted mailing intervention on adherence among older adults at risk for nonadherence, and to examine associations of individual and plan characteristics with adherence.
Materials and methods
Among adults enrolled in a Medicare Advantage Plan with prescription drug coverage from May 2014 to June 2015, those identified as eligible for the mailing intervention had a late refill for oral antidiabetic medication, statin, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker medication and were previously unreachable by telephone. Pharmacy claims data were analyzed with the outcome of 6-month proportion of days covered (PDC) before and after the mailing. The t-test and chi-square analyses were used to evaluate univariate associations. Multivariable linear and logistic regression models were conducted to assess relative covariate effects. A sub-analysis of those with at least one medication fill post-mailing was also performed.
Results
A total of 460 non-adherent individuals aged 70±10.5 years, with 50.2% female and 66.7% white individuals, were included. Of those who were mailed a letter, 24.1% became adherent to the specified maintenance medication. Those who received >30-day supplies were more than twice as likely to become adherent after the mailed letter than those who received 30-day supplies or less (P<0.05). Baseline higher PDC was also associated with greater adherence post-mailing (P<0.01). A total of 284 (61.7%) individuals filled their medication at least once after the mailed letter; of those, 39.1% became adherent (mean [SD] change in PDC =0.15 [±0.28]).
Conclusion
Our findings suggest that a single mailed letter improved medication adherence by 24.1% in adults with chronic conditions. As a health plan seeking to improve its customers’ well-being and outcomes, Cigna continues to utilize targeted mail interventions to improve medication adherence.
Supplementary materials
Table S1 Sub-analysis of letter recipients with medication filled after letter was sent (n=284)
Table S2 Sub-analysis of letter recipients with medication filled after letter was sent (n=284)
Acknowledgments
This work was funded by Cigna. Some of these results have been submitted for presentation as a peer-reviewed poster at the American Managed Care & Specialty Pharmacy Annual Meeting in April 2016. The abstract was awarded a bronze medal and appears in the conference proceedings.
Author contributions
Esse, Abughosh, Serna, and Mann contributed to the study design. Mann collected the data. Abughosh, Esse, Castel, and Mann performed the data interpretation. Mann wrote the manuscript, and all authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.
Disclosure
At the time the work was conducted, Mann, Esse, Castel, and Serna were all full-time employees of Cigna Corporation or its operating subsidiaries. The authors report no other conflicts of interest in this work.