In Reply: We agree with Drs Guirguis and Zingone that medication therapy management, an unmeasurable variable in our study, may play an important role in reducing medication nonadherence among enrollees in Medicare drug plans. Despite the encouraging results of a small randomized controlled trial of the effects of an innovative face-to-face pharmacy care program on adherence and blood pressure among elderly persons,1 more study of the cost-effectiveness of this model is needed to justify nationwide implementation. For example, it is important to know whether the results of such intensive face-to-face clinical pharmacy services can be generalized from an academic medical center to large community populations and how such a program would be organized. Once Part D data are available, the Centers for Medicare & Medicaid Services should fund studies evaluating benefits and costs of alternative medication therapy management interventions in Part D plans (eg, face-to-face vs impersonal approaches) to inform future policies.
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