Receipt of High Risk Medications among Elderly Enrollees in Medicare Advantage Plans



Since 2005, the Centers for Medicare and Medicaid Services (CMS) has required all Medicare Advantage (MA) plans to report prescribing rates of high risk medications (HRM).


To determine predictors of receipt of HRMs, as defined by the National Committee for Quality Assurance’s “Drugs to Avoid in the Elderly” quality indicator, in a national sample of MA enrollees.


Retrospective analysis of Healthcare Effectiveness Data and Information Set (HEDIS) data for 6,204,824 enrollees, aged 65 years or older, enrolled in 415 MA plans in 2009. To identify predictors of HRM use, we fit generalized linear models and modeled outcomes on the risk-difference scale.


Receipt or non-receipt of one or two HRMs.


Approximately 21 % of MA enrollees received at least one HRM and 4.8 % received at least two. In fully adjusted models, females had a 10.6 (95 % CI: 10.0–11.2) higher percentage point rate of receipt than males, and residence in any of the Southern United States divisions was associated with a greater than 10 percentage point higher rate, as compared with the reference New England division. Higher rates were also observed among enrollees with low personal income (6.5 percentage points, 95 % CI: 5.5–7.5), relative to those without low income and those residing in areas in the lowest quintile of socioeconomic status (2.7 points, 95 % CI: 1.9–3.4) relative to persons residing in the highest quintile. Enrollees ≥ 85 years old, black enrollees, and other minority groups were less likely to receive these medications. Over 38 % of MA enrollees residing in the hospital referral region of Albany, Georgia received at least one HRM, a rate four times higher than the referral region with the lowest rate (Mason City, Iowa).


Use of HRMs among MA enrollees varies widely by geographic region. Persons living in the Southern region of the U.S., whites, women, and persons of low personal income and socioeconomic status are more likely to receive HRMs.

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The authors would like to thank Dr. Gabriela Schmajuk for her assistance with the SES index score analysis. Both Dr. Qato and Dr. Trivedi had full access to all the data in the study and take full responsibility for the integrity of the data and the accuracy of the data analysis.


This work was supported by the Agency for Healthcare Research and Quality (1T32HS019657) and National Institute on Aging (5RC1AG036158). The funding sources had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; or preparation of the manuscript.

Prior Presentations

These findings were presented during an oral presentation at the AcademyHealth conference in June, 2012, in Orlando, Florida.

Conflict of Interest

The authors declare that they do not have any conflicts of interest.

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Corresponding author

Correspondence to Amal N. Trivedi MD, MPH.

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Qato, D.M., Trivedi, A.N. Receipt of High Risk Medications among Elderly Enrollees in Medicare Advantage Plans. J GEN INTERN MED 28, 546–553 (2013).

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  • high risk medications
  • geriatric prescribing
  • potentially inappropriate medication
  • quality prescribing
  • disparities