Background: Nonadherence to medications is a concern due to adverse outcomes and higher costs of care. The Centers for Medicare and Medicaid Services has made adherence a key measurement for Star ratings. Objective: To evaluate the impact of a collaborative pilot program between a third-party payer, local pharmacy organization, and academic institution focusing on improving medication adherence with community pharmacies. Methods: Twenty-five community pharmacies implemented adherence-based interventions in patients ≥65 years old, who were Medicare Advantage Plan members, taking targeted medications (statins, oral diabetic medications, angiotensin-converting enzyme inhibitors [ACE-Is] and angiotensin receptor blockers [ARBs]). Outcome measures were (1) pharmacy intervention completion rate, (2) type of adherence interventions, (3) change in the proportion of days covered (PDC) following pharmacist intervention based on adherence group, and (4) nonadherence barriers. Results: A total of 1263 interventions met the eligibility criteria, and common interventions included explaining the benefit of the medication (n = 453, 35.9%) and provider follow-up (n = 109, 8.6%). Among nonadherent subjects who became adherent, the mean PDC increased by 14% (74%-88%, P < .0001), with a 12% decrease in mean PDC score in the nonadherent who remained nonadherent group (71%-58%, P < .0001). Common patient barriers for nonadherence were forgetfulness (n = 451, 35.7%) and denial (n = 84, 6.7%). System and therapeutic barriers included complexity (n = 155, 12.3%) and adverse side effects (n = 42, 3.3%). Conclusion: This collaborative effort successfully implemented a community pharmacist-led adherence intervention in 25 independent pharmacies. Our findings highlight increased interactions with patients and in some cases improved adherence measures. Future research must include implementation outcomes in order to effectively implement these interventions in the community pharmacy setting.

Objectives: To evaluate differences in receipt of diabetes care services: A1C test, foot examination, dilated eye examination, flu vaccination and serum cholesterol test between privately health-insured and publicly health-insured diabetic subjects. Methods: Using the household component Medical Expenditure Panel Data Survey (MEPS) 2015 consolidated data, a secondary data analysis was carried out. Logistic regression was used to separately model the effect of insurance type on the receipt of each of the diabetes-care quality indicators: dilated eye examination, serum cholesterol test, foot examination, flu vaccination and A1C test. For subjects aged 18-64 yrs., private insurance-only versus public insurance-only users were compared using 348 eligible subjects, while for subjects above 64 yrs., Medicare-only versus Medicare plus private insurance users were compared using sample size of 240. Effects of age, education level, gender, income and race were controlled. Results: For subjects 18-64 yrs., the receipt of eye examination (OR 0.85, 95% CI: 0.51-1.41); foot examination (OR 0.716, 95% CI: 0.42-1.22), A1C test (OR 0.73, 95% CI: 0.40-1.34); flu vaccination (OR 0.901, 95% CI: 0.55-1.48); and serum cholesterol test (OR 1.35, 95% CI: 0.64-2.87); were not significantly associated with type of insurance coverage. Comparing Medicare versus Medicare plus private coverage for subjects above 64 yrs., the receipt of eye examination (OR 1.76, 95% CI: 0.88-3.50); feet examination (OR 1.13, 95% CI: 0.57-2.26), A1C test (OR 0.89, 95% CI: 0.38-2.08); and flu vaccination (OR 1.26, 95% CI: 0.63-2.50) were not significantly associated with type of coverage while odds of blood cholesterol test is higher (OR 1.35, 95% CI: 0.64-2.87) with Medicare plus private coverage users. Conclusions: Receipt of most key preventive and monitoring services among people with diabetes is similar between private and public insurance users, however elderly diabetic Medicare users with any additional private coverage are a little more likely to receive blood cholesterol test than Medicare-only users.