Common conditions impacting Medicare beneficiaries

As of 2018, nearly 60 million Americans are enrolled in Medicare. Most beneficiaries are age 65 or older, but younger members can qualify if they have certain disabilities or end-stage renal disease.

Given their age and pre-existing conditions, members of this population face unique challenges that must be carefully managed by their healthcare providers, health plans, and PBM.

Here are some of the top chronic conditions that are most prevalent within this group, according to CMS:

  • Ischemic Heart Disease
  • Chronic Kidney Disease
  • Hyperlipidemia
  • Hypertension
  • Depression
  • Diabetes
  • Arthritis

However, many Medicare beneficiaries are managing multiple diseases. In fact, more than two-thirds of these members have two or more chronic conditions, and about 14% have six or more. This can contribute to rising costs, lower adherence rates, and scrutiny by CMS for Medicare plans.

For beneficiaries on fixed incomes, affording the monthly out-of-pocket costs associated with multiple maintenance medications can be challenging. There are also a number of factors associated with multiple treatment regimens, particularly for elderly patients, that create a greater risk of non-adherence.

Managing adherence for these populations is critical for PBMs–but it can require them to go off-road to make a real impact. Through our advanced clinical and technological programs, Abarca has several programs to help improve members’ adherence. We are even helping a Medicare client achieve year-over-year increases in adherence during the COVID-19 pandemic.

At Abarca, we have a proven track record of helping our Medicare clients earn 5-star ratings from CMS–and provide a better experience for beneficiaries. And we are always looking for new ways to deliver.

This blog was written by Ana M. Rivera, PharmD, Clinical Programs Manager at Abarca, and Dan Reedy, Associate Director, Pricing and Underwriting Strategies at Abarca. 


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