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

Abstract

Objectives Previous studies found that racial and ethnic minorities may be less likely than non-Hispanic Whites (Whites) to meet existing Medicare medication therapy management (MTM) eligibility criteria. To address these issues, the Centers for Medicare & Medicaid Services (CMS) proposed alternative Medicare MTM eligibility criteria for 2015. Due to opposition to other Part D reforms proposed simultaneously by various stakeholders, CMS rescinded all proposed reforms. This study was conducted to determine whether non-Hispanic Blacks (Blacks) and Hispanics have lower likelihood of meeting the proposed 2015 Medicare MTM eligibility criteria. Methods This retrospective observational analysis used Medical Expenditure Panel Survey data (2010-2011). The final study sample was comprised of 2,721 Whites (weighted to 37,185,896), 917 Blacks (weighted to 4,665,644), and 538 Hispanics (weighted to 3,532,882). Chi-square tests were used to examine racial and ethnic disparities in meeting proposed 2015 MTM eligibility criteria and each component of proposed 2015 MTM eligibility criteria. In multivariate analysis, a logistic regression model was used to control for population socio-demographic and health-related characteristics. Key Findings Compared to Whites with a proportion of MTM eligibility of 58.82%, the eligible proportion was 57.09% (P=0.20) for Blacks, and 48.97% (P<0.0001) for Hispanics, respectively. According to multivariate logistic regression, odds ratios of meeting MTM eligibility for Blacks and Hispanics compared to Whites were 0.74 (95% Confidence Internal [CI] = 0.62-0.88) and 0.53 (95% CI=0.43-0.67), respectively. Conclusions The proposed 2015 MTM eligibility criteria would not eliminate racial and ethnic disparities in MTM eligibility. Alternative MTM eligibility criteria should be devised.

Predictive value positive of MTM eligibility criteria under MMA and ACA in identifying individuals with medication utilization issues

“…For example, Wang et al . reported lower likelihood of MTM eligibility among minorities than Whites under the MMA and ACA MTM eligibility criteria . Future research may need to consider other alternative MTM eligibility criteria.…”

“…Previous studies have documented the shortcomings of the MMA MTM eligibility criteria and emphasized the importance of modifying the design of MTM programs to increase accessibility and benefit individuals who most need MTM services . Wang et al .…”

“…Wang et al . reported a series of findings on racial and ethnic disparity implications of the MMA MTM eligibility criteria . Stuart et al .…”

“…[11] Previous studies have documented the shortcomings of the MMA MTM eligibility criteria and emphasized the importance of modifying the design of MTM programs to increase accessibility and benefit individuals who most need MTM services. [12][13][14][15][16][17][18][19] Wang et al reported a series of findings on racial and ethnic disparity implications of the MMA MTM eligibility criteria. [12][13][14][15][16][17] Stuart et al indicated that current MMA MTM eligibility criteria are not optimally targeted to capture patients in greatest need of MTMthose with underuse of or poor adherence to medications for chronic conditions.…”

“…[12][13][14][15][16][17][18][19] Wang et al reported a series of findings on racial and ethnic disparity implications of the MMA MTM eligibility criteria. [12][13][14][15][16][17] Stuart et al indicated that current MMA MTM eligibility criteria are not optimally targeted to capture patients in greatest need of MTMthose with underuse of or poor adherence to medications for chronic conditions. [18] Lee et al found that increasing the threshold number of Part D drugs while decreasing the threshold of annual drug costs in the 2013 MMA MTM eligibility criteria would result in better performance of these criteria in identifying patients who had drug therapy problems and were in greatest need of MTM services.…”