A prescriber fax program alerting physicians when their diabetic patients have not had a statin claim demonstrated a statistically significant boost in statin use and could be a valuable addition to Medicare Advantage Prescription Drug (MA-PD) plans’ efforts to improve both medication adherence and star ratings, according to a new study from Prime Therapeutics LLC. That program was shown to be especially effective when combined with pharmacist outreach, researchers observed.
Cholesterol-lowering statin drugs have been shown to prevent cardiovascular disease and reduce health care costs. Statins began to play a bigger role in the CMS star ratings in 2019, when the Pharmacy Quality Alliance-developed Statin Use in Persons with Diabetes (SUPD) measure was added to the Part D calculations and when the NCQA-developed Statin Therapy for Patients with Cardiovascular Disease measure was added to the Part C ratings. Both had a weighting value of 1, but with the 2021 ratings that came out last fall, SUPD became one of four triple-weighted Part D measures, which include Medication Adherence for Cholesterol (Statins).
With the launch of a prescriber fax program in 2019, Prime Therapeutics began identifying diabetic members who did not have a statin pharmacy benefit claim and sending faxes to the member’s prescriber recommending statin therapy. To assess the effectiveness of such a program, Prime researchers monitored the claims of two member groups comprising individuals who had one paid claim for a statin during 2018 and 2019 and were continuously enrolled with one of Prime’s owner/client Blue Cross Blue Shield Medicare plans. The PBM compared the claims of 17,304 members in the control group and 58,237 members in the SUPD prescriber fax group.
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