Prescription Drug Use Among Medicare Patients Highly Inconsistent

Prescription drug use of both effective and risky drugs among Medicare patients varies throughout the United States, showing that location plays an important role in the quality and cost of medical care patients receive, according to a new report from the Dartmouth Atlas Project.

A region’s Medicare health status accounted for less than a third of the variation in total prescription drug use, and higher spending was not related to higher use of proven drug therapies, researchers also found.

In this first such study from Dartmouth on prescription drug use, researchers looked at how prescription drugs are used by Medicare beneficiaries in the program’s Part D drug benefit, which had 37 million enrollees in 2012. The report separates the country into 306 regional healthcare markets and examines variations among them in the quantity and quality of prescription drug use, spending, and use of brand name drugs.

The report looked at prescription use in three categories:

  • Drug therapies proven to be effective for patients who have suffered heart attacks, have diabetes, or have broken a bone;
  • Discretionary medications, which have less clear benefits, but may be effective for some patients who take them; and
  • Potentially harmful medications, for which risks generally outweigh benefits.

Researchers found that the average Medicare Part D patient filled 49 standardized 30-day prescriptions in 2010. Patients in Miami filled the most prescriptions, an average of 63 per year, compared to patients in Grand Junction, Colo., who filled 39 prescriptions per year.

Regarding the use of proven drug therapies, including beta blockers and statins for heart attack and osteoporosis victims, respectively, researchers found that statin use ranged from a high in Ogden, Utah (94 percent) to a low in Abilene, Texas (44 percent). The regions that excelled in beta blocker use did not necessarily achieve similar results with statin therapy, despite the fact that both beta blocker therapy and strict control of cholesterol levels are recommended by the National Committee for Quality Assurance (NCQA) for the same condition in the same patients.

More than one in four Medicare Part D beneficiaries filled at least one prescription in 2010 for medications identified as high-risk for patients over age 65. Patients in Alexandria, La., were more than three times as likely to receive at least one high-risk medication as patients in Rochester, Minn.

Spending varied nearly threefold across regions, with a $2,968 difference between the lowest-spending region — St. Cloud, Minn. ($1,770) — and the highest spending region, Miami ($4,738).

Overall, 26.3 percent of prescriptions were filled as a brand-name product in 2010. Patients in Manhattan were more than twice as likely to fill a prescription for a brand-name product than patients in La Crosse, Wis.

The full report, The Dartmouth Atlas of Medicare Prescription Drug Use, and complete data tables can be found here.

Source: Robert Wood Johnson Foundation, October 15, 2013

Pharmacists and Medication Adherence: Brief Interventions, Motivational Interviewing and Telepharmacy describes a number of interventions in which pharmacists help to guide patients and health plan members to higher levels of medication adherence — programs that take place in the pharmacy, in the physician practice, or virtually, and answers more than 30 questions on the role of the pharmacist in reducing non-adherence.

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