Year of Publication


Degree Name

Master of Science (MS)

Document Type

Master's Thesis




Pharmaceutical Sciences

First Advisor

Dr. Jeffery Talbert


Objectives: Managed care organizations reduce healthcare costs and may improve patient health outcomes by encouraging better control of prevalent chronic diseases. The purpose of this study was to determine whether changing from a fee-for-service program to a capitated managed care program improved medication adherence for Medicaid patients in Kentucky with hypertension, hypercholesterolemia, or type 2 diabetes.

Methods: We conducted a quasi-experimental study of patients enrolled in Kentucky Medicaid to evaluate the impact of transitioning to capitated managed care in November 2011. Medication adherence was measured using the proportion of days covered (PDC) method. Multivariable analyses measured the adjusted differences in adherence as a result of the implementation of capitated managed care.

Results: Adjusted analyses indicate an average decrease in PDC by about 17-22 days of therapy coverage in the post-policy time period. However, no significant difference in adherence rate changes between the treatment and control populations were observed.

Conclusions: Results indicate clinically inconclusive evidence regarding the immediate effect of the implementation of Medicaid managed care in Kentucky on medication adherence rates in patients with prevalent chronic diseases. There is a need to address the decline in average adherence rates, and the efficacy of Medicaid managed care based on medication adherence.

Digital Object Identifier (DOI)