Five for Friday June 14: Celebrating Success in Advancing Medication Use Quality

PQA, in partnership with Inovalon, is evaluating the impact of the Medicare out-of-pocket cost cap for insulin on persistence to basal insulin.

A large body of evidence has linked improved medication adherence to improved outcomes in patients with diabetes. However, the cost of insulin presents a significant burden to patients, contributing to a decrease in medication-taking behavior. The analysis will provide early insights into the impact of the insulin price cap on patient persistence. Learn more about the analysis below.

We also highlight  our members' perspectives on medication adherence, social determinants of health and oral anticancer medication. If you have news you'd like for us to spotlight in an upcoming Five For Friday, send us an email! 

-- Razanne Oueini, PharmD, MSc, PQA Senior Manager, Performance Measurement 

Evaluating Medication Adherence with Utilization and Costs   

recent Humana study evaluated the association between the number of CMS Star Ratings quality measures of medication adherence missed for diabetes, hypertension, and hyperlipidemia and health care utilization and costs for patients enrolled in a Medicare Advantage prescription drug plan. Missing Star Ratings quality measures for medication adherence was associated with an increased likelihood of health care resource utilization and increased costs for patients taking medications to treat diabetes, hypertension, and hyperlipidemia.

Connecting Patients and Community Resources   
Crystal Lennartz, president of Health Mart & Health Mart Atlas, discussed the retailer's work in social determinants of health and how community pharmacies can be an access point to help customers. The executive also gave an update on its new platform, Rx Health Mart, a place where consumers may search to find financial assistance, food pantries, medical care, transportation and other free or reduced-cost services in their area.

Measuring Adherence to OAMs  
RealChemistry's Tom Valuck and David Blaisdell discuss the complex challenges of improving the quality of oral anticancer medication use. Although standardized and endorsed oral anticancer adherence or persistence measures could provide valuable insight into the problem of nonadherence, strategies for measuring interventions that improve access and communication should also be pursued. They ask, "What priorities should measure developers consider to help stakeholders understand and improve adherence or persistence to oral anticancer medications?" 

Evaluating the Impact of Medicare Cost Cap for Insulin on Patient Persistence

PQA, in partnership with Inovalon, will evaluate the impact of Medicare cost cap for insulin on the Persistence to Basal Insulin (PST-INS) health plan performance measure. The analysis will compare measure rates before and after the implementation of the cost cap in a large nationally representative sample of Medicare Advantage beneficiaries.

PST-INS is a health plan performance measure that evaluates the percentage of individuals 18 years and older who were treatment-persistent to basal insulin during a measurement year. The PST-INS measure is included in the Medicare Part D Patient Safety Reports, which provide confidential rates to Part D plan sponsors, enabling them to monitor their own progress and to compare their performance to overall averages, as well as on the Medicare Part D display page for public reporting.

Results from the analysis will be shared in early 2025. This project is supported by Eli Lilly and Company and Novo Nordisk.


Your Next Engagement Opportunities

Network, Learn and Collaborate with PQA

  • Join us for PQA's next Quality Forum Webinar on Thursday, July 18, 1-2 pm ET. The PQA Quality Forum Webinar is a regular, recurring series on best practices and emerging trends in medication use quality, medication services and other initiatives that can improve health care quality. Register today.

  • Save the date for the next PQA Quality Forum Webinar on August 14, 1-2 pm ET. The PQA Quality Essentials Webinar provides education on the fundamentals of quality measurement, which is important for effective measure implementation and performance, and information about where and how PQA quality measures are used. 

  • Stay up to date on everything happening at PQA! Sign up to receive updates from PQA, including announcements, webinar and event registration, and regular newsletters. Plus, connect with Micah Cost and follow Pharmacy Quality Alliance on LinkedIn for regular insights on quality medication use.

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