Comprehensive Medication Reviews in Medicare Were Not Associated With Reduced Central Nervous System-Active
Anna Hung1,2,3, Lauren E Wilson1, Juliessa M Pavon4,5,6,7
1Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
Journal of the American Geriatrics Society
|December 27, 2025
Summary
Comprehensive medication reviews (CMRs) did not reduce central nervous system (CNS)-active polypharmacy in older Medicare enrollees. This study found no significant difference in medication discontinuation rates between CMR recipients and non-recipients.
Area of Science:
- Geriatric Medicine
- Health Services Research
- Pharmacology
Background:
- Central nervous system (CNS)-active polypharmacy poses significant risks, including cognitive impairment and falls, particularly in older adults.
- Medicare Part D implemented CNS-active polypharmacy as a display measure in 2021 to monitor and mitigate these risks.
- Enrollees in the Medicare Part D Medication Therapy Management (MTM) program are at higher risk and eligible for Comprehensive Medication Reviews (CMRs).
Purpose of the Study:
- To evaluate the association between CMRs and the discontinuation of CNS-active medications.
- To assess the impact of CMRs on reducing CNS-active polypharmacy among MTM enrollees in 2021.
Main Methods:
- An observational study utilizing inverse probability of treatment weighting.
- Analysis of 5% Medicare fee-for-service claims and enrollment data from 2021.
- Comparison of time to discontinuation of at least one CNS-active medication between CMR recipients and non-recipients.
Main Results:
- Of 2702 eligible MTM enrollees, 35.9% received a CMR.
- CMR recipients, compared to non-recipients, showed similar rates of discontinuing at least one CNS-active medication within one year (11.5% vs. 13.2%).
- Weighted analyses revealed no significant difference in discontinuation likelihood between the two groups (HR=1.03, 95% CI=0.94-1.12).
Conclusions:
- CMRs were not associated with a reduction in CNS-active polypharmacy among older adults in the initial year of its Medicare Part D display measure implementation.
- Further research is warranted to explore the reasons for this lack of association and its persistence over time.
Related Concept Videos
01:15Drug Dosing: Geriatric Patients
206
Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
206
01:28Drug Therapy
229
The advent of drug therapy has profoundly shaped modern mental health care, providing targeted treatments for a range of psychological disorders. Psychotherapeutic drugs, classified into antianxiety, antidepressant, and antipsychotic medications, address symptoms across anxiety disorders, mood disorders, and schizophrenia. While these medications have transformed patient outcomes, they require careful management due to their potential side effects and limitations.
Antianxiety Medications
Antianxiety Medications
229
01:27Pharmacodynamics in Geriatric Patients: Effects of Age
174
Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...
174
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism
178
Geriatric patients show significant variation in how their bodies process medications, which can change how effective and safe treatments are. The liver is the primary organ where drug metabolism occurs, involving two main types of chemical reactions: phase I and II. Phase I metabolism is driven by the cytochrome P450 enzyme system, which includes key types such as CYP3A, CYP2D6, and CYP2C9. Research indicates that while aging doesn't notably alter the levels or activity of these enzymes, it...
178
01:22Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption
205
As individuals age, their body's physiology evolves, affecting drug pharmacokinetics. The most apparent changes occur in the gastrointestinal tract, where an increase in gastric pH, a delay in gastric emptying, and a reduction in gastrointestinal motility are observed. Remarkably, these changes do not substantially modify the absorption of orally administered drugs, particularly those absorbed via passive diffusion.Transdermal drug delivery emerges as a highly viable method for older adults due...
205
01:00Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution
209
Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are...
209