0
Research
Racial and ethnic disparities in meeting Part D MTM eligibility criteria among the non-Medicare population
Junling Wang; Lawrence M. Brown; Song Hee Hong
J Am Pharm Assoc (2003) 2012;52:e87-e96. doi:10.1331/JAPhA.2012.11146

Abstract

Objective  To determine whether racial and ethnic minorities were less likely to meet the Medicare Part D eligibility criteria for medication therapy management (MTM) services compared with whites among the adult non-Medicare population, because some non-Medicare health plans have followed the Medicare example.

Design  Cross-sectional observational study.

Setting  United States, 2007–08.

Patients  16,691 white, 5,923 black, and 9,242 Hispanic adults (>17 years) among the non-Medicare population.

Intervention  Analysis of the Medical Expenditure Panel Survey. MTM eligibility criteria used by Part D plans in 2008 and 2010–11 were examined. Main and sensitivity analyses were conducted to represent the entire range of the eligibility thresholds used by Part D plans. Analyses also were conducted among individuals with heart disease, diabetes, and hypertension.

Main outcome measures  Proportions and odds of patients meeting Part D MTM eligibility criteria.

Results  According to the main analysis examining 2008 eligibility criteria, whites had a higher proportion of eligible individuals than did blacks (3.73% vs. 2.57%) and Hispanics (1.53%, P < 0.05 for both comparisons). According to survey-weighted logistic regression adjusting for patient characteristics, blacks and Hispanics had odds ratios for MTM eligibility of 0.60 (95% CI 0.46–0.79) and 0.54 (0.40–0.72), respectively, compared with whites. Sensitivity analyses, analyses examining 2010–11 eligibility criteria, and analyses among individuals with heart disease, diabetes, and hypertension produced similar findings.

Conclusion  Racial and ethnic minorities have lower odds for meeting Part D MTM eligibility criteria than whites among the adult non-Medicare population. MTM eligibility criteria need to be modified to address these disparities.

Sign In
APhA Members 
Welcome to JAPhA.org! Please log in below using your APhA username and password. Update your APhA profile.
Not a Subscriber
New to JAPhA? Become an APhA member to receive a full subscription to both the print and online editions.

OR

Register for a FREE limited account to benefit from personalization features such as alerts.

References

Centers for Medicare & Medicaid Services.  Department of Health & Human Services. Medicare Program; Medicare prescription drug benefit: final rule.  Fed Regist.  2005; 70: 4193– 585. [PubMed]
 
Wang J, Mullins CD, Brown LM, et al.  Disparity implications of Medicare eligibility criteria for medication therapy management services.  Health Serv Res.  2010; 45: 1061– 82. [PubMed]
 
Centers for Medicare & Medicaid Services.  Department of Health & Human Services. 2011 Medicare Part D medication therapy management (MTM) programs. Accessed at www.cms.gov/PrescriptionDrugCovContra/Downloads/MTMFactSheet2011063011Final.pdf,  August 15, 2011.
 
Bluml BM.  Definition of medication therapy management: development of professionwide consensus.  J Am Pharm Assoc.  2005; 45: 566– 72.
 
Byrd L, Fletcher A, Menifield C.  Disparities in health care: minority elders at risk.  ABNF J.  2007; 18: 51– 5. [PubMed]
 
Gornick ME.  The association of race/socioeconomic status and use of Medicare services: a little-known failure in access to care.  Ann N Y Acad Sci.  1999; 896: 497– 500. [PubMed]
 
Gornick ME.  Disparities in Medicare services: potential causes, plausible explanations, and recommendations.  Health Care Financ Rev.  2000; 21: 23– 43. [PubMed]
 
Gornick ME, Eggers PW, Reilly TW, et al.  Effects of race and income on mortality and use of services among Medicare beneficiaries.  N Engl J Med.  1996; 335: 791– 9. [PubMed]
 
Briesacher B, Limcangco R, Gaskin D.  Racial and ethnic disparities in prescription coverage and medication use.  Health Care Financ Rev.  2003; 25: 63– 76. [PubMed]
 
Schore J, Brown R, Lavin B.  Racial disparities in prescription drug use among dually eligible beneficiaries.  Health Care Financ Rev.  2003; 25: 77– 90. [PubMed]
 
Gaskin DJ, Briesacher BA, Limcangco R, et al.  Exploring racial and ethnic disparities in prescription drug spending and use among Medicare beneficiaries.  Am J Geriatr Pharmacother.  2006; 4: 96– 111. [PubMed]
 
Eichner J, Vladeck BC.  Medicare as a catalyst for reducing health disparities.  Health Aff (Millwood).  2005; 24: 365– 75. [PubMed]
 
Schommer JC, Planas LG, Johnson KA, Doucette WR.  Pharmacist-provided medication therapy management (part 2): payer perspective in 2007.  J Am Pharm Assoc.  2008; 48: 478– 86.
 
Medication Management Systems, Inc. Introduction to Medication Management Systems, Inc.: comprehensive medication therapy management solutions. Accessed at www.medsmanagement.com/pdf/MMSServices_032010.pdf,  October 25, 2011.
 
Pharmacy Society of Wisconsin.  About WPQC. Accessed at www.pswi.org/displaycommon.cfm?an=1&subarticlenbr=38,  October 25, 2011.
 
Han E, Liu GG.  Racial disparities in prescription drug use for mental illness among population in US.  J Ment Health Policy Econ.  2005; 8: 131– 43. [PubMed]
 
Khandker RK, Simoni-Wastila LJ.  Differences in prescription drug utilization and expenditures between Blacks and Whites in the Georgia Medicaid population.  Inquiry.  1998; 35: 78– 87. [PubMed]
 
Wang J, Zuckerman IH, Miller NA, et al.  Utilizing new prescription drugs: disparities among non-Hispanic whites, non-Hispanic blacks, and Hispanic whites.  Health Serv Res.  2007; 42: 1499– 519. [PubMed]
 
Wang J, White-Means SI, Hufstader MA, Walker GD.  The economic implications of the racial and ethnic disparities in the use of selective serotonin reuptake inhibitors.  Curr Med Res Opin.  2007; 23: 853– 63. [PubMed]
 
Wang J, Noel JM, Zuckerman IH, et al.  Disparities in access to essential new prescription drugs between non-Hispanic whites, non-Hispanic blacks, and Hispanic whites.  Med Care Res Rev.  2006; 63: 742– 63. [PubMed]
 
Hebert PL, Sisk JE, Howell EA.  When does a difference become a disparity? Conceptualizing racial and ethnic disparities in health.  Health Aff (Millwood).  2008; 27: 374– 82. [PubMed]
 
Centers for Medicare & Medicaid Services, Department of Health & Human Services.  Medicare Part D medication therapy management (MTM) programs: 2010 fact sheet. Accessed at www.cms.hhs.gov/Prescription-DrugCovContra/Downloads/MTMFactSheet.pdf,  August 16, 2011.
 
Agency for Healthcare Research and Quality.  2010 national healthcare disparities report. Accessed at www.ahrq.gov/qual/nhdr10/nhdr10.pdf,  December 18, 2011.
 
Agency for Healthcare Research and Quality.  Medical Expenditure Panel Survey. Accessed at www.meps.ahrq.gov/mepsweb,  August 15, 2011.
 
Daniel GW, Malone DC.  Characteristics of older adults who meet the annual prescription drug expenditure threshold for Medicare medication therapy management programs.  J Manag Care Pharm.  2007; 13: 142– 54. [PubMed]
 
Andersen RM, Davidson PL.  Improving access to care in America: individual and contextual factors. In: Andersen RM, Rice TH, Kominski GF, Eds.  Changing the U.S. health care system: key issues in health services, policy and management. 3rd ed.  San Francisco, CA:  Jossey-Bass;  2007: 3– 32.
 
Fishman J, P O’Dwyer, Lu HL, et al.  Race, treatment preferences, and hospice enrollment: eligibility criteria may exclude patients with the greatest needs for care.  Cancer.  2009; 115: 689– 97. [PubMed]
 
Guirguis AB, Zingone MM.  Medication therapy management and cost-related medication nonadherence.  JAMA.  2008; 300: 1130. [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Please read the other comments before you post yours. Comments are moderated and will appear on the site at the discertion of the editorial staff.
* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content

Customize your page view by dragging & repositioning the boxes below.

JAPhA Articles
Topic Collections
Advertisement
 
  • Print
  • PDF Download
  • Email
  • Share
  • Get Citation
  • Submit Comment
  • Article Alerts
    Please Wait... Processing your request... Please Wait.
    You must sign in to sign-up for alerts.

    Please confirm that your email address is correct, so you can successfully receive this alert.

  • Letters To Editor
  • Reprints