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Expert offers specific actions for managed care execs to take
More than one quarter, or about 5 million, of Medicare Part D enrollees taking blood pressure medications are not taking them as prescribed, according to a study published in the CDC’s monthly report Vital Signs.
High blood pressure is a leading cause of heart disease, stroke, kidney disease and death. Unfortunately, almost one in three U.S. adults (approximately 75 million) has high blood pressure, and nearly half of that group (about 34 million) doesn’t have it under control.
As part of CDC’s ongoing efforts to monitor trends and risk factors contributing to cardiovascular disease, Study author Matthew Ritchey, DPT, PT, OCS, MPH, epidemiologist, CDC’s Division for Heart Disease and Stroke Prevention and colleagues collaborated with colleagues at CMS to look at blood pressure medicine nonadherence among Medicare Part D enrollees aged 65 years and older.
“The findings of this study will help inform future clinical and public health interventions to improve medication adherence and blood pressure control,” says Ritchey.
Ritchey and colleagues studied prescription medicine claims data involving almost 19 million people enrolled in Medicare Part D with either Medicare Advantage or Medicare fee-for-service health insurance coverage during 2014 who were using blood pressure medicine.
“We measured the percentage of days a person filled and had access to their blood pressure medicine,” Ritchey says. “If a person had access less than 80% of the time, we considered them to be non-adherent. We then analyzed differences in nonadherence rates based on factors including geography, race/ethnicity, income status and by the type of antihypertensive medication.”
This was the first study of its kind to identify considerable geographic variation in blood pressure medicine nonadherence at the county level.
Blood pressure medication nonadherence is a problem for all race-ethnicities and geographies, according to the report. However, certain groups were identified that had particularly high rates, according to Ritchey. For example, compared to one in four Medicare Part D enrollees who were Asian or non-Hispanic white not taking their blood pressure medication as directed, one in three enrollees who were black, Hispanic or American Indian/Alaska Natives were not doing so-putting them at higher risk of heart attack, stroke, kidney disease and death.
Geographic differences also exist. The southern U.S. states, Puerto Rico and the U.S. Virgin Islands have the highest overall rates of people on Medicare Part D that aren’t taking their medicine as directed, while North Dakota, Wisconsin and Minnesota have the lowest rates.
High blood pressure is one of the most treatable risk factors for cardiovascular disease – once diagnosed, it can effectively and inexpensively be controlled, according to the authors.
“Moreover, upfront investment in improving medication adherence and better controlling blood pressure among patients has been shown to decrease future healthcare costs by decreasing patients’ risk for having a heart attack or stroke, or developing chronic kidney disease,” Ritchey says. “This research is beneficial because it helps reveal patterns of and disparities in nonadherence. By revealing how many patients are not following doctor’s orders-and if those patients are clustered in specific geographic pockets-we can better target clinical and public health efforts around them.”
Everyone has a stake in efforts to improve pressure control nationwide, including managed care plans, but accomplishing this requires coordination across a broad range of stakeholders, says Ritchey, and managed care executives can play a significant role in improving blood pressure medicine adherence and protecting patient health.
“Specific actions might include providing incentives for simplified treatments and removing or lowering co-pays for chronic disease medicines,” he says. “Previous research shows any copay reduces medicine use, even among those that don’t have financial constraints, so reducing and eliminating copays is a key action that can be taken.”
For example, another CDC study showed that, in 2014, one quarter of prescription fills for blood pressure medicines among patients with commercial insurance still required a patient contribution (e.g., copay) greater than $5 compared to only around 15% for patients with Medicare coverage and less than 1% with Medicaid coverage.
“Another opportunity is to use administrative claims data to identify patients who are not taking their medicine correctly and support coordinated care among prescribers, pharmacists and patients,” he says. “Finally, consider increasing access to medication therapy management services for at-risk patients with chronic disease.”