Should Medicare rely on high drug spending as a criterion for medication therapy management programmes? Linda Simoni-Wastila a , Jingjing Qian a,b , Yu-Jung Jenny Wei a , Bruce Stuart a , Ilene H. Zuckerman a , Thomas Shaffer a , Anand A. Dalal c and Lynda Bryant-Comstock c a Peter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, b Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, Auburn, Alabama, and c GlaxoSmithKline, Research Triangle Park, North Carolina, USA Abstract Objectives The goal of Medicare Part D medication therapy management programmes (MTMPs) is to optimize medication use by beneficiaries. The Centers for Medicare & Medicaid Services require prescription drug plans (PDPs) to consider numbers of chronic medications and conditions, and total Part D spending when targeting beneficiaries for MTMPs. However, there is no explicit evidence base establishing these criteria. The objectives were to examine the associations of Part D spending with medication use and adherence among Medicare beneficiaries with chronic obstructive pulmonary disease (COPD). Methods This retrospective cross-sectional study used a 5% random sample of Medicare beneficiaries with COPD enrolled in stand-alone PDPs and Medicare Parts A and B in 2006–2007 (n = 72 912). Maintenance medication use and adherence for COPD were meas- ured in three domains: discontinuation, duration of therapy and proportion of days covered. Key findings Proportions of beneficiaries using COPD maintenance medications increased with Part D spending, from 33.4% (quintile 1) to 60.5% (quintile 5), after covariant adjustment. Among maintenance medication users, the adjusted proportions of beneficiaries exhibiting better adherence also increased with spending, with the top 20% of spenders having the highest proportion of beneficiaries exhibiting good adherence. Adjusted proportions of beneficiaries discontinuing medications decreased with increased Part D spending. Conclusions The Part D MTMP spending criterion (US$4000 in 2007; US$3000 in 2010) may be an inappropriate target for identifying Medicare beneficiaries in need of adherence counselling. Findings suggest higher spenders may have learned healthy adherence behav- iours, whereas lower spenders may be prone to discontinue medication and/or demonstrate poor adherence behaviours. Keywords chronic obstructive pulmonary disease; Medicare beneficiaries; medication adherence; medication therapy management programmes; spending Introduction The US Medicare Modernization Act (MMA) requires all Part D prescription drug plans (PDPs) to offer qualifying patients individualized medication therapy management pro- gramme services (MTMPs). [1] The intent of MTMPs is to ‘ensure that covered Part D drugs are appropriately used to optimize therapeutic outcomes through improved medication use.’ [1] ‘Appropriate’ medication use spans many domains, including indication for use, poly-pharmacy, adverse effects, monitoring, dosing parameters and adherence to prescribed regimens. Prescription drug plans are required to identify qualifying beneficiaries using three criteria: the presence of multiple chronic conditions, the use of multiple unique chronic medications, and high drug spending. The PDPs have flexibility in how they define the number of conditions and medications that count towards the first two criteria. [2] For example, in 2010, 60.5% of MTMPs targeted beneficiaries filling at least eight covered Part D drugs, whereas 5.8% of MTMPs focused on beneficiaries filling at least two Correspondence: Jingjing Qian, Pharmacy Care Systems, Auburn University Harrison School of Pharmacy, 038 James E. Foy Hall, Auburn, AL 36849, USA. E-mail: jzq0004@auburn.edu Research Paper JPHSR 2012, 3: 213–219 © 2012 The Authors JPHSR © 2012 Royal Pharmaceutical Society Received April 24, 2012 Accepted July 24, 2012 DOI 10.1111/j.1759-8893.2012.00102.x ISSN 1759-8885 213