Potential health implications of racial and ethnic disparities in meeting MTM eligibility criteria

Abstract

Background Previous studies have found that racial and ethnic minorities would be less likely to meet the Medicare eligibility criteria for medication therapy management (MTM) services than their non-Hispanic White counterparts. Objectives To examine whether racial and ethnic disparities in health status, health services utilization and costs, and medication utilization patterns among MTM-ineligible individuals differed from MTM-eligible individuals. Methods This study analyzed Medicare beneficiaries in 2004–2005 Medicare Current Beneficiary Survey. Various multivariate regressions were employed depending on the nature of dependent variables. Interaction terms between the dummy variables for Blacks (and Hispanics) and MTM eligibility were included to test whether disparity patterns varied between MTM-ineligible and MTM-eligible individuals. Main and sensitivity analyses were conducted for MTM eligibility thresholds for 2006 and 2010. Results Based on the main analysis for 2006 MTM eligibility criteria, the proportions for self-reported good health status for Whites and Blacks were 82.82% vs. 70.75%, respectively (difference=12.07%; P< .001), among MTM-ineligible population; and 56.98% vs. 52.14%, respectively (difference=4.84%; P= .31), among MTM-eligible population. The difference between these differences was 7.23% (P< .001). In the adjusted logistic regression, the interaction effect for Blacks and MTM eligibility had an OR of 1.57 (95% Confidence Interval, or CI=0.98–2.52) on multiplicative term and difference in odds of 2.38 (95% CI=1.54–3.22) on additive term. Analyses for disparities between Whites and Hispanics found similar disparity patterns. All analyses for 2006 and 2010 eligibility criteria generally reported similar patterns. Analyses of other measures did not find greater racial or ethnic disparities among the MTM-ineligible than MTM-eligible individuals. Conclusions Disparities in MTM eligibility may aggravate existing racial and ethnic disparities in health outcomes. However, disparities in MTM eligibility may not aggravate existing disparities in health services utilization and costs and medication utilization patterns. Future studies should examine the effects of Medicare Part D on these disparities.

Disparity implications of proposed 2015 Medicare eligibility criteria for medication therapy management services

“…This study's findings concerning disparities follow patterns similar to those identified in prior research, as summarized in Table . It was previously reported that according to 2006 MTM eligibility thresholds (the most restrictive since MTM implementation), the adjusted odds ratios for meeting eligibility criteria for blacks and Hispanics compared to whites were 0.36–0.60 ( P <0.05) and 0.13–0.46 ( P <0.05) respectively .…”

“…To address the problem of disparities in MTM eligibility, a fourth‐stage strategy, a comprehensive approach, needs to be taken. Changing MTM eligibility criteria can only be one prong of the solution; addressing the pattern of lower utilization of prescription drugs among minorities than whites is critical …”

“…To date, participation rates for MTM programmes have never exceeded 15% . Additionally, MTM eligibility criteria are implicated in racial and ethnic disparities in receiving MTM services . Non‐Hispanic blacks (blacks) and Hispanics may be less likely to meet MTM eligibility criteria because said criteria are predominantly based on prescription drug utilization, and these minorities typically use fewer prescription drugs and incur lower drug costs compared to their non‐Hispanic white (white) counterparts …”

Predictors of Medication-Related Problems among Medicaid Patients Participating in a Pharmacist-Provided Telephonic Medication Therapy Management Program

“…Stakeholders, however, have continued to question the value of current Medicare Part D eligibility criteria, and the Centers for Medicare and Medicaid Services is currently considering significant changes to these criteria . Further evaluation of predictors of MRPs and, subsequently, MTM eligibility criteria is warranted among both Medicare beneficiaries and other populations.…”

Historical trend of racial and ethnic disparities in meeting Medicare medication therapy management eligibility in non-Medicare population

“…1 These reports and other studies have demonstrated that minorities are more likely to receive poor quality of care and have poor access to preventive care, acute treatment, and chronic disease management in comparison to non-Hispanic Whites (referred to hereafter as ‘Whites’). 1-4 A recent study found that eliminating racial and ethnic disparities would have reduced $229.4 billion in direct medical costs in the United States in 2003-2006. Additionally it was found that during this period, 30.6% of direct medical expenditures for racial and ethnic minorities including non-Hispanic Blacks (referred to hereafter as ‘Blacks’) and Hispanics came from additional costs due to health inequalities.…”