Medication adherence and Medicare STAR ratings

Accountable Care Organizations (ACO) and commercial payers are watching medication adherence closely, as it is a triple-weighted measure for Medicare STAR ratings. One way to effectively help with this measure is to consider ordering 90-day supplies for chronic medications such as oral diabetic meds, ACEi or ARBs and statin medications.

Medication adherence is measured by counting patients’ missed days from due refills. If a patient misses more than 60 days/year filling their chronic medications, they will fail the adherence measure and the STAR rating for the organization will drop. Medication adherence is one of the most important parts of patient therapy. We can prescribe as many medications as are necessary, but if the patient is not consistently taking them, outcomes will not improve.

If we can decrease the amount of times patients must go to the pharmacy to pick up a refill, the patient is less likely to miss days, and remains more adherent to medications. The easiest way to impact this is by prescribing 90-day supplies for chronic meds. Many insurance companies prefer 90-day prescriptions for this very reason. Studies have shown adherence rates improve when 90-day prescriptions are ordered, however, some insurance companies still require a 30-day limit. If this is the case, the pharmacy can actually dispense only 30-day supplies at a time without needing a new prescription. The pharmacy cannot dispense more than the quantity ordered.

Example:

  • Metformin 500mg daily #90 with 3 refills, the pharmacy can dispense #30 at a time if required by insurance. 
  • Metformin 500mg daily #30 with 11 refills, the pharmacy cannot dispense #90 at a time without a new prescription.

Consider ordering 90-day supplies for oral diabetic medications, ACEi/ARBs and statin medications, and consider the quantity needed for a full 90days. This will not only help with patient adherence, but will also limit communication from the pharmacy for medication renewal requests.