95 percent of the time, yet HIV patients often stray from therapy. When caring for HIV patients, physicians rely on observations and patients’ own reports of compliance. However, literature often points to the inaccuracy of patients’ self-reported adherence.

Objectives

MemberHealth, a pharmacy benefits provider, that administers the Community CCRx^sm Medicare Part D Prescription Drug Plan, sought to increase the number of HAART beneficiaries with a Medication Possession Ratio (MPR) > 95%. MPR has been widely used and validated as a proxy for drug adherence.

Target Audience

Community CCRx members who had claims for antiretroviral drugs and an MPR < 95% were included in an intervention. Their physicians were the target audience for a letter-based initiative to increase HAART adherence.

Solution

MemberHealth retrospectively identified HAART pharmacy claims from June 2006 through January 2007 for Community CCRx members, including those in Employer Group Waiver Plans. Beneficiaries taking antiretrovirals with an MPR < 95% were identified. The group included 1,285 members, with an average age of 48. Some were eligible for both Medicaid and Medicare. At baseline, their average MPR was 73%.

Letters were sent to prescribing physicians with patient-specific MPR data, duration, and start and end date of therapy. In addition to providing quantifiable information about compliance, the letter referenced the consequences of nonadherence and the importance of a multidisciplinary approach to improve adherence. It encouraged physicians to use the data to discuss medication adherence with noncompliant patients.

Results

MemberHealth’s study showed an immediate increase in MPR among HIV patients whose physicians received MPR data and educational materials reinforcing a discussion about compliance. At 90, 180, and 265 days post-intervention, an aggregate analysis of adherence to antiretroviral therapy revealed a significant increase in baseline MPR by 10%, 7%, and 6% respectively. Post-intervention results at 90, 180, and 265 days indicated 46% (n=588), 32% (n=406), and 27% (n=350) of intervention patients achieved an MPR > 95%. The decrease in average MPR over time supports the value of frequently providing compliance measurement and educational interventions to physicians of HIV patients.