Medicare Advantage plans have been encouraged by the Centers for Medicare and Medicaid Services (CMS) to include $0 copay prescription costs for medications that work to reduce heart attacks and strokes in the plans for 2014. Some plans will be including $0 copay drugs that fight high cholesterol and high blood pressure.
Medicare Advantage to fight heart disease
In a coordinated effort, CMS is working with the Centers for Disease Control and several other federal, state and private sector partners to prevent 1 million heart attacks and strokes by 2017. Formally known as the Million Hearts, the initiative emphasizes cardiovascular health through education and proven therapies to reduce heart attacks and strokes. The four points to the initiative focus on ABCS
- Appropriate aspirin therapy
- Blood pressure control
- Cholesterol management
- Smoking cessation
Prescription drugs at low or no copay
Medicare Advantage plans with the Part D prescription drug inclusion are in a perfect position to help reduce heart attacks and strokes with the proper combination of medications. CMS strongly encouraged Medicare Advantage plans and Part D Prescription drug plans include generic medications that lower blood pressure at a $0 or very low copay.
Reduce heart attacks and strokes
By removing any financial barrier from the Medicare beneficiary from taking the medications, CMS hopes that more Medicare Advantage plan members will start and maintain a drug therapy to improve their cardiovascular health. Some plans have also included generic cholesterol lowering medications at low or $0 copay.
Some of the generic drugs that have been included at $0 copay in some Medicare Advantage plans are
Cholesterol lowering statins
- Atorvastatin Calcium
- Lovastatin
- Pravastatin Sodium
- Simvastatin
High Blood Pressure Control
- Benazepril HCL
- Benazepril – Hydrochlorothiazide
- Captopril
- Enalapril Maleate
- Lisinopril
- Lisinopril – Hydrochlorothiazide
- Losartan Potassium
- Losartan – Hydrochlorothiazide
- Ramipril
- Valsartan – Hydrochlorothiazide
Medication review
CMS also encouraged the Medicare Advantage plans to develop and offer a Medication Therapy Management (MTM) program for beneficiaries who fill one or more of the anti-hypertensive medications. The MTM would include a comprehensive review of the medications, any other drugs the patient might be taking and instructions for the recipient to be proactive and self-manage their prescription use.
Centers for Medicare and Medicaid Services heart healthy drug encouragement
April 1, 2013
Announcement of Calendar Year (CY) 2014 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter
Pages 149 – 151
Million HeartsTM Initiatives
Million HeartsTM, a U.S. Department of Health and Human Services initiative co-led by the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) and executed by a host of federal, state, and private sector partners, aims to prevent one million heart attacks and strokes by 2017. More information about the Million HeartsTM initiative can be found at http://millionhearts.hhs.gov/index.html.
A recent study by Roger and colleagues (Circulation. 2012; 125:e2-e220) found that each year, Americans suffer 2 million heart attacks and strokes and 800,000 citizens die from heart attacks, stroke, and other cardiovascular diseases. The trauma of these largely preventable events affects families, workplaces, and communities and costs the nation over $444 billion in lost productivity and treatment as found by Heidenriech and colleagues (Circulation. 2011; 123:933-4).
Along with community-focused efforts to reduce tobacco use and sodium and trans fat consumption, the primary clinical aim in Million HeartsTM is to achieve excellence in the ABCS: aspirin for those at risk, blood pressure control, cholesterol management, and smoking cessation. Getting to excellence means making the ABCS a priority for professionals, health systems, insurers, employers, and people with or at risk for cardiovascular disease and by deploying effective teams, health information technology, and incentives for high performance.
The first target of the Million HeartsTM initiative is to control high blood pressure. Nearly one in three American adults (67 million) has high blood pressure, and more than half (36 million) are not under control. According to the Medicare Current Beneficiary Survey (MCBS), overall, more than 66 percent of Medicare beneficiaries have high blood pressure. High blood pressure contributes to nearly 1,000 deaths per day and accounts for nearly $131 billion in direct healthcare costs a year. Reducing the average systolic blood pressure by 12-13 mmHg could reduce stroke by 37%, coronary heart disease by 21%, cardiovascular disease mortality by 25%, and all-cause mortality by 13%.
The 36 million people with uncontrolled hypertension fall into the following three categories:
• 16 million are aware of their diagnosis and on treatment, but their hypertension is still uncontrolled;
• 14.1 million are not even aware that they have high blood pressure; and
• 5.7 million are aware but untreated.
Viewed through the insurance lens, of those with uncontrolled hypertension:
• 14. 1 million are Medicare beneficiaries;
• 14.06 million have private insurance;
• 2.3 million have other public insurance; and
• 5.26 million have no insurance.
Medicare Advantage Organizations (MAOs) and Part D Plan (PDP) Sponsors are well-positioned to contribute to rapid improvement in detection and control of hypertension. Drawing attention to the scope of the problem and prioritizing control is a first step. Improving access to blood pressure medication by removing financial barriers such as co-pays could improve blood pressure control. Furthermore, MAOs and PDP sponsors can contribute to better detection and control by facilitating home blood pressure monitoring, the sharing of those data with the treating provider, and the timely return of treatment advice to the patient.
CMS is suggesting several actions that MAOs and PDP Sponsors could take to improve access and adherence to anti-hypertensive medications.
First, for those plans that offer a $0 or a very low cost-share tier, we encourage, but do not require, sponsors to place blood pressure medications on this tier.
Second, we encourage, but do not require, sponsors to offer Medication Therapy Management (MTM) to beneficiaries who fill one or more prescriptions for anti-hypertensive medications. The CMS requirements for targeting beneficiaries for the MTM program are considered to be a minimum; sponsors are encouraged to offer MTM services to an expanded population of beneficiaries who may not meet the eligibility criteria per CMS’ specifications, but who could benefit from MTM services. Offering MTM, including a comprehensive medication review, to this population could help improve their blood pressure control, increase their adherence to these vital medications, and empower these beneficiaries to self-manage their medications and their health condition. However, this would not result in additional payment under Medicare Part D. We also encourage sponsors to consider other interventions, aside from a comprehensive medication review as part of MTM, such as adherence programs, targeted medication reviews, etc., which may improve outcomes for this population and support the initiative.
###
