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Evaluation of Specialized Medication Packaging Combined With Medication Therapy Management: Adherence, Outcomes, and Costs Among Medicaid Patients

Zillich, Alan J. PharmD*,†; Jaynes, Heather A. W. RN, MS; Snyder, Margie E. PharmD, MPH; Harrison, Jeff PhD; Hudmon, Karen Suchanek DrPH, MS, RPh; de Moor, Carl PhD§; French, Dustin D. PhD*

doi: 10.1097/MLR.0b013e3182549d48
Original Articles

Background: This study evaluates the effect of a program combing specialized medication packaging and telephonic medication therapy management on medication adherence, health care utilization, and costs among Medicaid patients.

Research Design: A retrospective cohort design compared Medicaid participants who voluntarily enrolled in the program (n=1007) compared with those who did not (n=13,614). Main outcome measures were medication adherence at 12 months, hospital admissions and emergency department visits at 6 and 12 months, and total paid claim costs at 6 and 12 months. Multivariate regression models were used to adjust for the effect of age, sex, race, comorbidities, and 12-month preenrollment health care utilization.

Results: Measures of medication adherence were significantly improved in the program cohort compared with the usual care cohort. At 6 months, adjusted all-cause hospitalization was marginally less in the program cohort compared with the usual care cohort [odds ratio=0.73, 95% confidence interval (CI), 0.54–1.0, P=0.05]. No statistically significant differences were observed between the 2 cohorts for any of the other adjusted utilization endpoints at 6 or 12 months. Adjusted total cost at 6 and 12 months were higher in the program cohort (6-month cost ratio=1.76, 95% CI,1.65–1.89; 12-month cost ratio=1.84, 95% CI,1.72–1.97), primarily because of an increase in prescription costs. Emergency department visits and hospitalization costs did not differ between groups.

Conclusions: The program improved measures of medication adherence, but the effect on health care utilization and nonpharmacy costs at 6 and 12 months was not different from the usual care group. Reasons for these findings may reflect differences in the delivery of the specialized packaging and the medication therapy management program, health care behaviors in this Medicaid cohort, unadjusted confounding, or time required for the benefit of the intervention to manifest.

*Center for Implementing Evidence-Based Practices, Roudebush VA Medical Center, Indianapolis

Purdue University College of Pharmacy, West Lafayette, IN

School of Pharmacy, University of Auckland, Auckland, New Zealand

§Epidemiology NA, Registrat-MAPI, Lexington, KY

Supported by Indiana Office of Medicaid Policy and Planning. The sponsor had no role in the design and conduct of the study, the collection, management, analysis, or interpretation of the data, or preparation or approval of the manuscript. The sponsor provided a review of the manuscript. A portion of A.J.Z.’s time was supported by a Career Development award from the Department of Veterans Affairs, Health Services Research and Development (RCD 06-304-1), and M.E.S.’s effort was supported in part by KL2 RR025760 (A. Shekhar, PI.). J.H.’s collaboration was supported in part by a Senior Scholar Award from Fulbright New Zealand. The corresponding author had full access to all study data and takes responsibility for the integrity of the data and accuracy of the analyses.

All authors report no conflicts of interest for the past 3 years.

Reprints: Alan J. Zillich, PharmD, Center for Implementing Evidence-based Practices, Roudebush VA Medical Center and Purdue University College of Pharmacy, W7555 Myers Building, Wishard Health Services, 1001W. 10th Street, Indianapolis, IN 46202-2879. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.