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Medication Adherence for Medicare Members

Notice to Providers: Patients with Health Partners Medicare may receive a call from these following contracted programs on behalf of HPP.

Magellan Rx

HPP has partnered with Magellan Rx to do outreach to Health Partners Medicare members, providers and/or pharmacies to ensure that members are filling and taking medications as prescribed.

Medication Adherence Program Description: Outreach to Medicare members who are in the denominator for one or more of the STARs medication adherence measures. Magellan Rx focuses on increasing medication adherence rates in patients with diabetes, hypertension and/or hyperlipidemia. The goal is to increase the percentage of members who are at least 80% adherent throughout the calendar year to their prescription for an oral diabetes medication, RAS antagonist and/or statin medication.

Statin Use in Persons with Diabetes (SUPD) Program Description: Increase the percentage of members 40–75 years of age who have at least two fills of diabetes medications during the calendar year AND have a fill for at least one statin or statin combination medication in the calendar year.

Members who qualify for the medication adherence program and/or SUPD program may receive a call from Magellan Rx on behalf of HPP to discuss their medications.

Tabula Rasa

HPP has partnered with Tabula Rasa Healthcare (MedWiseRx) to complete comprehensive medication reviews for qualifying Medicare members.

Members must meet ALL of the following criteria to qualify for CMR Program:

  • Have at least three of these chronic conditions: bone disease (e.g., arthritis, osteoporosis), congestive heart failure (CHF), diabetes, dyslipidemia, hypertension, respiratory disease (e.g., asthma, Chronic Obstructive Pulmonary Disease (COPD))
  • Take at least seven chronic, Part D covered medications, AND
  • Are likely to have medication costs of Part D covered medications greater than $4,696 for the 2022 year.

Medication Management Support

90-day Prescriptions and Deliveries/Mail Order

When appropriate, write 90-day prescriptions for our members with chronic conditions. 90-day prescriptions are:

  • Cost efficient as members have the potential to get 3 months’ worth of medications for the cost of 2 months.
  • Positive influences on compliance with medication regimen as patients in DSNP have $0 copay for all drugs and non-DSNP patients have $0 copay for preferred generics. Review our Health Partners Medicare formularies.

*Note: 90-day supplies are not available for specialty drugs.

Some HPP participating pharmacies offer a medication home delivery option. Please review the list of participating pharmacies on our Provider Directory webpage; this list is updated frequently.

Other Home Delivery Services

CVS Simple Dose allows members to receive a 30-day supply via USPS or pick up at a CVS Pharmacy. CVS Simple Dos offers 30-day supply only. Members can ask about this program at any CVS Pharmacy.

HomeFree Pharmacy delivers a monthly pill pack. A RN/LPN or pharmacy technician will visit members in their home to review medications; perform medication reconciliation; work with providers for any prescription issues or needs; provide monthly reminder outreaches; and answer any questions about the medications or disease process. 

Over-the-Counter Benefits: All Health Partners Medicare members have an over-the-counter (OTC) benefit that assists with covering the costs of eligible products, such as vitamins, first aid and pain relief. The benefit allowance varies by plan type.

Barriers to Filling Prescriptions/Taking Medications

Barriers

Solutions

Too many medications to take at different times throughout the day. Forgetfulness or lack of understanding about how to take the medication

Come up with a routine with your patients so they know when to take their medication. This can include setting a reminder or alarm and using pill boxes to organize medications.

New prescription or refills needed

Submit an e-prescription.

Unable to leave home to pick up medications from pharmacy

Talk to your patient about having their medications delivered to their door. Many pharmacies offer this service at no additional cost. See HPP Provider Website for more details.

Concern about side effects

Be sure to review potential side effects of medication and possible interactions with other medications.

Cost of medications is too high

Review potential cost savings in having their medication switched to 90-day refills/mail order where appropriate.

Patient doesn’t know why they are taking the medication

Review medications and treatment plan with your patient. Consider referral to care management or clinical pharmacist if available.

Resources

Download our Provider Resource Guide: Medication Adherence for Medicare Members, which contains the information found on this page in a more shareable format.