The effect of plan type and comprehensive medication reviews on high-risk medication use

Document Type


Publication Title

Journal of Managed Care and Specialty Pharmacy


BACKGROUND: In 2007, the Centers for Medicare & Medicaid Services(CMS) instituted a star rating system using performance outcome measuresto assess Medicare Advantage Prescription Drug (MAPD) andPrescription Drug Plan (PDP) providers.OBJECTIVE: To assess the relationship between 2 performance outcomemeasures for Medicare insurance providers, comprehensive medicationreviews (CMRs), and high-risk medication use.METHODS: This cross-sectional study included Medicare Part C and Part Dperformance data from the 2014 and 2015 calendar years. Performancedata were downloaded per Medicare contract from the CMS. We matchedMedicare insurance provider performance data with the enrollment data ofeach contract. Mann Whitney U and Spearman rho tests and a hierarchicallinear regression model assessed the relationship between provider characteristics,high-risk medication use, and CMR completion rate outcomemeasures.RESULTS: In 2014, an inverse correlation between CMR completion rateand high-risk medication use was identified among MAPD plan providers.This relationship was further strengthened in 2015. No correlation wasdetected between the CMR completion rate and high-risk medication useamong PDP plan providers in either year. A multivariate regression foundan inverse association with high-risk medication use among MAPD planproviders in comparison with PDP plan providers in 2014 (beta = -0.358,P < 0.001) and 2015 (beta = -0.350, P < 0.001), the CMR completion ratein 2015 (beta = -0.221, P < 0.001), and enrollee population size in 2015(beta = -0.203, P = 0.001).CONCLUSIONS: This study found that MAPD plan providers and higher CMRcompletion rates were associated with lower use of high-risk medicationsamong beneficiaries.

First Page


Last Page




Publication Date