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Effectiveness of mailed letters to improve medication adherence among Medicare Advantage Plan participants with chronic conditions

Authors Mann A, Esse TW, Serna O, Castel LD, Abughosh SM

Received 31 August 2018

Accepted for publication 1 December 2018

Published 20 December 2018 Volume 2019:13 Pages 37—46


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Amanda Mann,1 Tara W Esse,2 Omar Serna,2 Liana D Castel,3,4 Susan M Abughosh5

1Cigna-HealthSpring, Houston, TX, USA; 2CareAllies, Houston, TX, USA; 3Cigna Health and Life Insurance Company, Raleigh, NC, USA; 4Lundy-Fetterman School of Business, Campbell University, Buies Creek, NC, USA; 5Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA

Background: Medication adherence is associated with improved health outcomes in multiple chronic diseases. Information is needed on the effectiveness of specific adherence interventions. This study’s objectives were to quantify effects of a targeted mailing intervention on adherence among older adults at risk for nonadherence, and to examine associations of individual and plan characteristics with adherence.
Materials and methods: Among adults enrolled in a Medicare Advantage Plan with prescription drug coverage from May 2014 to June 2015, those identified as eligible for the mailing intervention had a late refill for oral antidiabetic medication, statin, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker medication and were previously unreachable by telephone. Pharmacy claims data were analyzed with the outcome of 6-month proportion of days covered (PDC) before and after the mailing. The t-test and chi-square analyses were used to evaluate univariate associations. Multivariable linear and logistic regression models were conducted to assess relative covariate effects. A sub-analysis of those with at least one medication fill post-mailing was also performed.
Results: A total of 460 non-adherent individuals aged 70±10.5 years, with 50.2% female and 66.7% white individuals, were included. Of those who were mailed a letter, 24.1% became adherent to the specified maintenance medication. Those who received >30-day supplies were more than twice as likely to become adherent after the mailed letter than those who received 30-day supplies or less (P<0.05). Baseline higher PDC was also associated with greater adherence post-mailing (P<0.01). A total of 284 (61.7%) individuals filled their medication at least once after the mailed letter; of those, 39.1% became adherent (mean [SD] change in PDC =0.15 [±0.28]).
Conclusion: Our findings suggest that a single mailed letter improved medication adherence by 24.1% in adults with chronic conditions. As a health plan seeking to improve its customers’ well-being and outcomes, Cigna continues to utilize targeted mail interventions to improve medication adherence.

Keywords: patient compliance, chronic disease, managed care programs, Medicare, Medicare Part D, Medicare Part C, mail distributions, population health, program evaluation

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