A new research letter published on Feb. 11 in The Journal of the American Medical Association: Internal Medicine reports that increased spending on pharmaceuticals including Part D plan payment before rebates, beneficiary out-of-pocket spending, and subsidies, does not necessarily correlate to better adherence among patients with heart failure (HF), and that more spending is not a mark of more efficient care.

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The study retrospectively analyzed 178,102 Medicare records for adult HF patients prescribed at least one drug regimen from one of three therapeutic classes: beta-blockers; angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor antagonists; diuretics. The main outcome, medication adherence, was measured by a medication possession ratio — the ratio of the total number of pills the patient had over the total number of pills the patient should have had during a one-year follow-up period.

Results showed that 52 percent of patients in the population had good adherence to heart failure medication. However, good adherence varied by region with the lowest rate at 36 percent and the highest 71 percent. Drug spending also varied across hospital referral regions, and although drug spending was modestly associated with treatment intensity, it did not correlate with adherence measures.

Lead author Yuting Zhang, PhD, Department of Health Policy and Management, University of Pittsburgh, and colleagues wrote, "we found that areas with higher drug spending did not have systematically better adherence. This suggests that areas with higher drug spending are not necessarily caring for patients with HF more efficiently."
 
Moving forward, they add that "areas with better adherence can provide a useful benchmark for what is achievable, and system-level quality measures that incorporate adherence, rather than focusing solely on drug spending, could promote more efficient use of resources."

Keywords: Medication Adherence, Angiotensin Receptor Antagonists, Follow-Up Studies, Diuretics, Heart Failure, Medicare, United States

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