Abstract
BACKGROUND: Central nervous system (CNS)-active polypharmacy is associated with increased risks such as impaired cognition and falls. In 2021, CNS-active polypharmacy was added as a Medicare Part D display measure to monitor for this risk. Enrollees in the Medicare Part D Medication Therapy Management program are at increased risk of CNS-active polypharmacy and are offered comprehensive medication reviews (CMRs) to optimize their medication management and reduce medication-related safety risks. OBJECTIVE: Evaluate the association of CMRs with CNS-active medication discontinuation among Medication Therapy Management enrollees in 2021. METHODS: Observational study applying inverse probability of treatment weights to compare the time until discontinuation of at least one medication contributing to CNS-active polypharmacy in CMR recipients versus non-recipients in 2021 using 5% Medicare fee-for-service claims and enrollment data. RESULTS: Of 2702 community-dwelling, Medication Therapy Management program enrollees ≥ 66 years of age with CNS-active polypharmacy, 969 (35.9%) were CMR recipients. Both CMR recipients and non-recipients were taking a median of four CNS-active medications. As compared to non-recipients pre-weighting, CMR recipients were more likely to use certain CNS-active medications, such as antidepressants, antiseizure medications, benzodiazepines, and nonbenzodiazepine sedative hypnotics and opioids. Compared to non-recipients pre-weighting, CMR recipients were also more likely to have more prescribers contributing to the CNS-active polypharmacy and to have a mix of prescriber types involved. Comparable numbers of CMR and non-CMR patients discontinued at least one CNS-active medication within 1 year (11.5% vs. 13.2%). In the weighted analyses, there was no difference in likelihood of discontinuation of at least one CNS-active medication between CMR recipients and non-recipients (hazard ratio = 1.03, 95% confidence interval = 0.94-1.12). CONCLUSIONS: CMRs were not associated with reduced CNS-active polypharmacy in older adults in the first year that it served as a Part D Display measure. Future research is needed to better understand why and whether this continues.