Impact of a pharmacy care management service on cardiometabolic medication adherence and resource use for Medicare Advantage beneficiaries

Q: What does this research mean for the field?

A real-world pharmacy care management program significantly improves medication adherence and reduces hospitalizations among Medicare Advantage beneficiaries with cardiometabolic conditions, with the greatest benefit observed in those nonadherent at baseline. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Shawn Hallinan; Loren Lidsky; Josh Benner; Stephen E. Jones; Elise Smith; Chronis Manolis; Chester B. Good; Niteesh K. Choudhry

doi:10.18553/jmcp.2025.31.11.1166

October 31, 2025Journal of Managed Care & Specialty PharmacyOpen Access

Impact of a pharmacy care management service on cardiometabolic medication adherence and resource use for Medicare Advantage beneficiaries

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Why the study?

Data on pharmacy care management programs primarily come from research-specific interventions, leaving their real-world benefits in patients with cardiometabolic conditions incompletely understood.

Does a comprehensive pharmacy care management program reduce all-cause hospitalizations and improve medication adherence in medically complex Medicare Advantage beneficiaries with cardiometabolic conditions?

Structured PICO

Does a comprehensive pharmacy care management program reduce all-cause hospitalizations and improve medication adherence in medically complex Medicare Advantage beneficiaries with cardiometabolic conditions?

P

Population

3,792 matched beneficiaries (632 PCM patients and 3,160 controls; out of 27,910 potentially eligible) with cardiometabolic conditions enrolled in the University of Pittsburgh Medical Center (UPMC) Medicare Advantage Prescription Drug (MAPD) health plan, mean age 69 (SD 10.1) years, 39% male, in the United States. Key inclusion: filled ≥8 chronic medications in the 180 days prior to screening, filled ≥2 prescriptions for a cardiometabolic condition in the 24 to 13-month period before screening, filled ≥1 prescription after enrollment, and continuously eligible for health plan benefits for ≥12 months before and after enrollment. Key exclusion: enrolled in a state-sponsored pharmaceutical assistance program, using a pharmacy providing similar services, in hospice, or declined participation and asked not to be contacted again.

I

Intervention

Pharmacy Care Management (PCM) program provided by a single pharmacy (Mosaic Pharmacy Service) for at least 12 months, consisting of a telephone onboarding appointment (medication history, prescription reconciliation, refill synchronization), home delivery of medications in specialized 30-day cycle pouch packaging sorted by day and time of dose with large photo/instruction labels, monthly telephone follow-up by a pharmacist or certified pharmacy technician, and as-needed clinical pharmacist consultations with physicians, patient education, and referrals to social support or case management programs.

C

Comparator

5:1 direct and propensity score-matched control group of eligible Medicare Advantage beneficiaries who could not be reached or declined to enroll in the PCM program and filled prescriptions at non-PCM pharmacies, with both groups receiving ongoing standard care management efforts employed by UPMC Medicare Advantage plans (comprehensive medication reviews, medication adherence campaigns, clinical programs for chronic conditions, accountable care incentives, and case management).

O

Outcome

All-cause hospitalizations over the 12-month follow-up period, assessed using adjudicated administrative claims data.hard clinical

Participation in an integrated pharmacy care management program significantly improved cardiometabolic medication adherence and reduced all-cause and cardiometabolic-specific hospitalizations over 12 months among medically complex Medicare Advantage beneficiaries, particularly those who were non-adherent at baseline.

Limitations

Deployed in a Medicare Advantage plan, so findings may not apply to settings with less medically complex or younger patients
PCM and control patients were not randomly assigned, and the opt-in nature of the program could have led to selection bias
Potential for unmeasured confounding between the groups remains despite matching and difference-in-difference adjustment
Assessed efficacy only in patients continuously exposed for 12 months, so the study does not determine the duration of exposure required for clinical benefit and results may differ for shorter exposure periods

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Supports pharmacy care management for cardiometabolic Medicare Advantage patients; leaves open causal confirmation via randomized trials.

Abstract

BACKGROUND: Prescribing rates and adherence to evidence-based cardiometabolic medications remain suboptimal. Many strategies to improve prescribing and adherence have been developed, among which pharmacy care management (PCM) programs are among the most consistently effective. Data on PCM programs come from studies that developed interventions specifically for research purposes. Benefits of real-world PCM programs for patients with cardiometabolic conditions are incompletely understood. OBJECTIVE: To evaluate the effect of an existing PCM program in individuals with cardiometabolic conditions, specifically, whether the program improved adherence to cardiometabolic medications and reduced all-cause and cardiometabolic-specific health care use and whether those nonadherent at baseline would benefit most. METHODS: We conducted a retrospective cohort study using adjudicated administrative claims data from a large regional Medicare Advantage Prescription Drug health plan. A total of 27,910 beneficiaries were identified as potentially eligible for the PCM program between December 2019 and November 2021. The cohort was restricted to individuals who filled at least 2 prescriptions for a cardiometabolic condition, filled at least 1 prescription after PCM enrollment, and were continuously eligible for health plan benefits for at least 12 months before and after enrollment. Potential controls met the same criteria but did not participate in the PCM program and filled prescriptions at non-PCM pharmacies. Control and PCM patients were matched 5:1 using direct and propensity score matching. The primary outcome was all-cause hospitalization over 12 months. Secondary outcomes included cardiometabolic medication adherence and disease-specific hospitalizations. We further evaluated program effects on rates of disease-specific hospitalization in patients nonadherent vs adherent at baseline. CONCLUSIONS: Compared with well-matched controls, PCM patients with cardiometabolic disease had significantly higher rates of medication adherence and significantly lower hospitalization rates during the 12-month follow-up period. This effect was greatest in patients nonadherent at baseline. Our results provide insights into how PCM programs achieve their benefits and underscore the value of targeting the PCM program to high-risk individuals.

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Cite This Study

Hallinan et al. (2025) studied this question.

synapsesocial.com/papers/6a8137f569a8c95c3f3c9c1f https://doi.org/10.18553/jmcp.2025.31.11.1166

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Impact of a pharmacy care management service on cardiometabolic medication adherence and resource use for Medicare Advantage beneficiaries

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Impact of a pharmacy care management service on cardiometabolic medication adherence and resource use for Medicare Advantage beneficiaries

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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