ST. PAUL, Minn., Sept. 29, 2016 /PRNewswire/ -- Prime Therapeutics LLC (Prime), a pharmacy benefit manager serving over 22 million members nationally, studied the success of its high-risk medication first fill intervention by analyzing its 1.1 million Medicare members. The program was designed to improve safety by attempting to prevent Medicare members from getting a second high-risk medication fill in the calendar year. The program resulted in a statistically significant lower high-risk medication usage from 2014 to 2015 compared to a control group.
According to the American Geriatrics Society1, high-risk medications carry a greater risk for adverse events among the elderly than for younger people. Safer alternatives are available for many high-risk medications, and the Centers for Medicare & Medicaid Services (CMS) tracks use as a Medicare quality of care display Star metric.
Prime used data from 26 Medicare contracts for the years 2014 and 2015. The intervention group included 21 contracts (965,687 members in 2014 and 1,131,564 members in 2015), and the control group included five contracts (13,373 members in 2014 and 52,791 members in 2015). The intervention group included members that had a letter sent to their prescriber only and members that had a letter sent to both their prescriber and the member. The control group had no letters sent. Both letters encouraged discontinuation of the high-risk medication.
The intervention group's high-risk medication percentage decreased from 9.9 percent in 2014 to 7.1 percent in 2015. The control group's percentage decreased from 5.6 percent to 4.1 percent in the same timeframe. The intervention group's percentage decreased 1.3 percentage points more than the control group, which was a statistically significant difference. This signals the intervention – the prescriber letter with or without a member letter – may have accounted for high-risk medication Star score improvement.
"This study shows that by bringing providers' and members' attention to the refilling of possible high-risk medications, behaviors may change," said Pat Gleason, PharmD, director of health outcomes at Prime. "Keeping our members safe with the medicines they are taking is extremely important to Prime. We want to help our health plan clients bring the highest quality programs to their members, which is why we continue to implement and evaluate intervention programs such as these."
The top five high-risk medications used by this Medicare population were zolpidem, cyclobenzaprine, estrogens, nitrofurantoin and amitriptyline. Future intervention programs for high-risk medications should focus on these five most prevalent drug classes.
About Prime Therapeutics
Prime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. Prime manages pharmacy benefits for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and delivers medicine to members, offering clinical services for people with complex medical conditions. Headquartered in St. Paul, Minn., Prime serves just over 22 million people. It is collectively owned by 14 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans.
For more information, visit www.primetherapeutics.com or follow @Prime_PBM on Twitter.
1. The American Geriatrics Society: http://www.americangeriatrics.org/press/listservs/wir_100915/id:5910
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Last updated on: 30/09/2016
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