Blue Cross launching call program to help members improve their medication adherence

Blue Cross Blue Shield of Michigan will begin the Blue Cross Quality Rating System Adherence Call Program this month. This program will help members who do not adhere to their medication regimen for these chronic conditions: cholesterol, diabetes and hypertension.

This program only includes our commercial, individual and small group plan members with Blue Cross pharmacy coverage. Medication adherence is one of the quality measures included in the Centers for Medicare & Medicaid Services quality rating system applicable to commercial individual and small group plans.

The call program identifies commercial members who have not consistently filled their medications beyond the initial prescription. Blue Cross pharmacists and pharmacist interns will call these members and offer to assist members in understanding their medication regimen.

After the initial phone call, our pharmacist or pharmacist intern will follow up by sending personalized letters and informational fliers to designated members. They will also send personalized letters to the member’s doctor, noting the reason the patient is not taking the prescribed medication.

How the program works

1. First, a Blue Cross pharmacist identifies a member with pharmacy coverage who is not adhering to his or her medication regimen for these chronic conditions: cholesterol, diabetes and hypertension.
2. A pharmacist or pharmacist intern calls the member.
3. If a member refuses to speak to the pharmacist or pharmacist intern, the member will receive informational fliers about his or her specific condition.
4. If a member participates in the call, the pharmacist or pharmacist intern tries to discover the reason that he or she is not adhering to the regimen. This reason falls into one of the following categories:
• Side effects: The member identifies specific concerns about or side effects from taking the medicine.
• Education: The member is unsure of the importance of taking prescription medication.
• Financial: The member identifies medication as too expensive.
• Forgetfulness: The member forgets to take medicine.
• Other: The member identifies other barriers such as transportation, dexterity and impairment.
5. The pharmacist or pharmacist intern counsels the member and sends a personalized letter about the discussion to the member and the member’s prescribing physician.
6. If a member requests more information, the pharmacist or pharmacist intern will send informational fliers about the member’s cholesterol, diabetes or hypertension condition.

Our pharmacists are available to support, not replace, the ongoing quality care you provide to our members. We encourage your patients to discuss suggested clinical recommendations and their barriers in adhering to medications with you at their next face-to-face appointment. Blue Cross realizes that each patient is unique, so we value your clinical judgment regarding drug therapy and patient care. Ultimately, the decision is up to you and your patient.

We appreciate your continued commitment to our members. If you have any questions, call our pharmacists at 313-448-4193, between 8 a.m. and 4 p.m., Monday through Friday.