High-Risk Medication Use Lower Among Medicare Advantage Beneficiaries

June 30, 2023 - High-risk medication use was lower among Medicare Advantage beneficiaries compared to those enrolled in traditional Medicare, a study published in JAMA Network Open revealed.

High-risk medications should be avoided for older patients due to age-related changes in pharmacodynamics and chronic illnesses that could increase the risk of avoidable hospitalization, healthcare spending, and death. Despite these risks, high-risk medications are frequently prescribed to older adults.

Policymakers have strived to reduce the use of high-risk medications by promoting alternative drugs, prior authorization, and geriatric consultation.

Medicare Advantage plans must report their high-risk medication use under the HEDIS DAE measure (Use of High-Risk Medications in Older Adults). Compared to traditional Medicare, these plans may better manage high-risk medication rates by employing more utilization management strategies.

Researchers used Medicare from 2013 to 2018 to determine how the rate of high-risk medication prescription fills differs between Medicare Advantage and traditional Medicare beneficiaries.

The sample included 5.6 million Medicare Advantage beneficiaries matched to 6.6 million traditional Medicare beneficiaries, resulting in 13.7 matched pairs of beneficiary years. Around 3,100 high-risk medications were identified in the HEDIS DAE measure over the study period.

High-risk medication prescriptions were more common among traditional Medicare beneficiaries, the study found. In 2013, Medicare Advantage beneficiaries were prescribed an average of 135.1 high-risk medications per 1,000 beneficiaries, while those in traditional Medicare were prescribed 165.6 high-risk medications per 1,000 beneficiaries.

High-risk medication rates were lower in Medicare Advantage across all drug categories, the study noted.

The rate of high-risk medications declined each year of the study period in both Medicare Advantage and traditional Medicare. By 2018, the number of high-risk medications per 1,000 beneficiaries fell to 41.5 in Medicare Advantage and 56.9 in traditional Medicare.

Trends were similar among beneficiaries who received at least one high-risk medication in a given year. For example, 11.9 percent of Medicare Advantage beneficiaries received at least one high-risk medication in 2013 compared to 14.4 percent in traditional Medicare. In 2018, these figures fell to 3.9 percent in Medicare Advantage and 5.3 percent in traditional Medicare.

Furthermore, enrollment in Medicare Advantage was associated with a lower likelihood of receiving high-risk medications. People enrolled in Medicare Advantage received 24.3 fewer high-risk medications per 1,000 beneficiaries compared to traditional Medicare beneficiaries.

Researchers identified certain disparities in high-risk medication use.

A one-year increase in age was associated with 2.4 fewer high-risk medications prescribed per 1,000 beneficiaries, while dual-eligibility status was associated with 5.9 more high-risk medications. Females were also more likely to be prescribed high-risk medications.

Asian, Black, and Hispanic beneficiaries were less likely to receive high-risk medications than White beneficiaries. But American Indian or Alaska Native beneficiaries received 6.0 more high-risk medications than White beneficiaries.

These racial disparities could result from underfunded infrastructure issues, clinician biases, and beneficiaries’ ability to afford medication. For example, past research has found that Black and Hispanic populations were less likely to be able to afford most medicines, which could contribute to lower rates of filled high-risk medications.

In addition to utilization management strategies, the lower rates of high-risk medication use in Medicare Advantage can be attributed to the program’s payment system incentivizing physicians to avoid costly care. Medicare Advantage plans also cover Part A and Part B services, meaning their prescribing practices may be more effective than those in traditional Medicare, researchers said.

“The persistently higher rates of [high-risk medications] among the traditional Medicare population suggest that [CMS] should consider more widespread incentivization of medication management to lower HRM rates to Medicare Advantage levels,” the study stated.

The agency could include high-risk medication rates as a quality measure for Medicare accountable care organizations (ACOs), researchers suggested.