Ethnic Disparities in Adherence to Antihypertensive Medications of Medicare Part D Beneficiaries

Abstract

BACKGROUND Nonadherence to antihypertensive medication is common and leads to adverse health outcomes. The Medicare Part D prescription drug program has decreased cost and increased access to medications, thus potentially improving medication adherence. OBJECTIVES To determine the level of adherence and characteristics of Part D beneficiaries associated with higher levels of antihypertensive medication adherence. DESIGN Retrospective analysis using Medicare claims and Part D event files for 2007. PARTICIPANTS Medicare Part D enrollees with prevalent uncomplicated hypertension who filled at least one antihypertensive prescription in 2006 and two prescriptions in 2007. MEASUREMENTS Medication adherence was defined by an average Medication Possession Ratio (MPR) of 80% or greater. Potential factors associated with adherence evaluated included age, sex, race/ethnicity, socioeconomic factors, comorbidity, medication use, copay, being in the coverage gap, and number of unique prescribers. RESULTS Among 168,522 Medicare Part D enrollees with prevalent uncomplicated hypertension receiving antihypertensive medicines in 2007, overall adherence was 79.5%. In univariate analysis, adherence varied significantly by most patient factors. In multivariable analysis, decreased odds of adherence persisted for blacks (OR 0.53, 95% CI 0.51–0.55), Hispanics (OR 0.58, 95% CI 0.55–0.61) and other non-white races (OR 0.80 95% CI 0.75–0.85) compared to whites. Increased comorbidity and concurrent medication use were also associated with reduced adherence. Adherence was significantly different across several geographic regions. CONCLUSION We identified a number of associations with patient factors and medication adherence to antihypertensive drugs, with significant differences in adherence by ethnicity. Improving adherence could have significant public health implications and could improve outcomes specific to hypertension as well as improved cost and healthcare utilization.

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

“…Our results showing continued existence of racial disparities in adherence in Medicare are consistent with the findings of other studies (Holmes et al, 2012;Lauffenburger et al, 2014;Zhang & Baik, 2013;Zhang et al, 2012). Three additional Part D-related issues set racial groups further apart.…”

Practical Approaches to Promote Adherence and Improve Blood Pressure Control in Black Patients

“…In the multivariate model, blacks had 47 % lower odds of adherence and Hispanics 42 % lower than whites. These data also suggest that improved cost and access (as through Medicare Part D) may not adequately reduce ethnic disparities in antihypertensive medication adherence [ 6 ].…”

“…In a retrospective cohort study of 168,522 Medicare Part D enrollees with hypertension, adherence was 67.8 % for blacks, 69.3 % for Hispanics, and 81.5 % for whites [ 6 ]. In the multivariate model, blacks had 47 % lower odds of adherence and Hispanics 42 % lower than whites.…”

Safe and Effective Use of Medicines for Ethnic Minorities - A Pharmacist- Delivered Counseling Program That Improves Adherence

“…The health-related problems and reduced work ability is enhanced for ethnic minorities due to language barriers, low health literacy, low self-efficacy, insufficient knowledge about disease and treatment as well as a culturally and an individually based incongruence between the view of the patient and health care provider [1,[7][8][9][10][11][12][13].…”