Disparity Implications of Medicare Eligibility Criteria for Medication Therapy Management Services

Abstract

Objective. To determine whether there would be racial and ethnic disparities in meeting eligibility criteria for medication therapy management (MTM) services implemented in 2006 for Medicare beneficiaries. Data Sources/Study Setting. Secondary data analyses of the Medical Expenditure Panel Survey (2004)(2005). Study Design. Logistic regression and recycled predictions were used to test the disparities in meeting eligibility criteria across racial and ethnic groups. The eligibility thresholds used by health plans in 2006 and new thresholds recommended for 2010 were examined. Racial and ethnic disparities were examined by comparing non-Hispanic blacks (blacks) with non-Hispanic whites (whites) and comparing Hispanics with whites, respectively. Disparities were also examined among individuals with severe health problems. Principal Findings. According to 2006 thresholds, the adjusted odds ratios for meeting eligibility criteria for blacks and Hispanics to whites were 0.36-0.60 (po.05) and 0.13-0.46 (po.05), respectively. Blacks and Hispanics would be 21-34 and 32-38 percent, respectively, less likely to be eligible than whites according to recycled predictions. Similar patterns were found using the 2010 eligibility thresholds and among individuals with severe health problems. Conclusions. There would be racial and ethnic disparities in meeting MTM eligibility criteria. Future research is warranted to confirm the findings using data after MTM implementation.

The Effects of Allostatic Load on Racial/Ethnic Mortality Differences in the United States

“…For instance, two recent studies have shown that (1) adherence to prescription medications treating hypertension, high cholesterol, and inflammation can reduce AL, even in older adults (Booth et al 2013), and (2) reductions in AL over time are followed by reductions in mortality risk . At the same time, non-Hispanic blacks are less likely to receive prescriptions for maintenance medications and pain medication (Institute of Medicine 2003), are less likely to qualify for Medicare coverage of medications (Wang et al 2010), are less likely to be insured (Carrasquillo et al 2000;Gaskin et al 2009;Haas et al 2003;Institute of Medicine 2003;LaVeist 2005LaVeist , 2002LaVeist et al 2007LaVeist et al , 2011Zuvekas and Taliaferro 2003), and are less likely to seek mental health assistance (Fiscella et al 2002). Such disparities in access to health-protecting resources, which are associated but not interchangeable with traditional socioeconomic variables like income and education, may explain why high baseline levels of AL may affect nonHispanic blacks to a greater extent than non-Hispanic whites.…”

Impact of Medicare Part D on Racial Disparities in Adherence to Cardiovascular Medications Among the Elderly

“…Introduction less likely to meet Part D utilization-based eligibility criteria for MTM services (Wang et al, 2010). Given the greater burden of CV diseases among minorities, particularly Blacks (Wong et al, 2002), potential unintended consequences of Part D benefit design and delivery structure may have especially negative consequences for these already burdened minority beneficiaries.…”

Medication Therapy Management Programs: Promises and Pitfalls

“…Wang et al noted that minority populations utilize fewer prescriptions despite having higher rates of chronic illnesses. 56 As a consequence, there is limited data on all outcomes related to MTM for minorities and less ability to generalize findings. Studies in the literature have employed a number of differing approaches to MTM: face-to-face, telephone, and mail.…”

“…African and Latino Americans tend to have higher rates of certain severe chronic conditions but also use fewer prescription drugs than European Americans. 56 To evalute the racial and ethnic disparities in meeting criteria of MTM services for Medicare beneficiaries, Wang et al (2010Wang et al ( , 2012) conducted a retrospective analysis of the nationally representative sample of Medicare beneficiaries in the Medical Expenditure Panel Survey (MEPS). 56,57 The results showed that the African and Latino populations were less likely to be eligible for MTM than were whites according to 2006 criteria and 2010 criteria.…”