Potential Health Implications of Medication Therapy Management Eligibility Criteria in the Patient Protection and Affordable Care Act Across Racial and Ethnic Groups

Abstract

Background The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) requires Part D plans to establish programs to provide medication therapy management (MTM) services starting from 2006. MTM services have been found to improve patient outcomes from pharmacotherapy, reduce emergency room visits and hospitalizations, and reduce health care costs in a cost-effective fashion. However, previous research found that Non-Hispanic Blacks (Blacks) and Hispanics may be less likely to be eligible for MTM services than Non-Hispanic Whites (Whites) among the Medicare population according to current Medicare MTM eligibility criteria. This is because the Medicare MTM eligibility criteria are predominantly based on medication utilization and costs, while Blacks and Hispanics tend to use fewer prescription medications and incur lower prescription medication costs. The Patient Protection and Affordable Care Act (PPACA) laid out a set of MTM eligibility criteria for eligible entities to target patients for MTM services: “(1) take 4 or more prescribed medications …; (2) take any ‘high risk’ medications; (3) have 2 or more chronic diseases… or (4) have undergone a transition of care, or other factors… that are likely to create a high risk of medication-related problems.” Objectives This study aimed to examine (1) racial/ethnic disparities in meeting the eligibility criteria for MTM services in PPACA among the Medicare population; and (2) whether there would be greater disparities in health and economic outcomes among MTM-ineligible than MTM-eligible groups. (If so, the PPACA MTM eligibility criteria may aggravate existing disparities.) Methods This was a retrospective cross-sectional analysis of Medicare Current Beneficiaries Survey (MCBS; 2007–2008). To determine medication characteristics, the Food and Drug Administration’s Electronic Orange Book was also used. Proportions of population eligible for MTM services based on the PPACA MTM eligibility criteria were compared across racial and ethnic groups using a chi-square test; a logistic regression model was used to adjust for population socio-demographic and health characteristics. Health and economic outcomes examined included health status (self-perceived good health status, number of chronic diseases, activities of daily living or ADLs, and instrumental activities of daily living or IADLs), health services utilization and costs (physician visits, emergency room visits, and total health care costs), and medication utilization patterns (generic dispensing ratio). To determine difference in disparities across MTM eligibility categories, difference-in-differences regressions of various functional forms were employed depending on the nature of the dependent variables. Interaction terms between the dummy variables for minority groups (e.g., Blacks or Hispanics) and MTM eligibility were included to test whether disparity patterns varied between MTM-ineligible and MTM-eligible individuals. Results The sample consisted of 12,966 Medicare beneficiaries, of which 11,...

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Hispanic health in the USA: a scoping review of the literature

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Higher Predictive Value Positive for MMA Than ACA MTM Eligibility Criteria Among Racial and Ethnic Minorities: An Observational Study

“…Racial and ethnic disparities in medication therapy management (MTM) eligibility criteria provide an example of institutionalized disparities in health care access. 8 - 18 According to the Medicare Prescription Drug and Modernization Act (MMA) of 2003, Medicare prescription drug (Part D) plans are required to offer MTM to patients with multiple chronic conditions, using multiple Part D drugs, and likely to incur annual costs for covered Part D drugs that exceed a prespecified threshold. 19 Minorities could particularly benefit from MTM services because they are more likely than whites to have certain chronic conditions (eg, diabetes, hypertension) targeted by MTM programs and undergo medical procedures that are indicators of poor management of these conditions.…”

“…Despite the importance of MTM for racial and ethnic minorities, a series of studies found that minorities are less likely to be eligible for MTM services than whites. 8 - 18 Such findings are not surprising because MTM eligibility criteria are predominantly utilization-based, and racial and ethnic minorities typically use fewer prescription medications and incur lower prescription drug costs than do whites. 20 - 24 Further aggravating racial and ethnic disparities is the fact that Part D plans have the flexibility to determine their own MTM eligibility thresholds within the legislative framework, and these Part D plans typically set their thresholds using the highest possible minimum.…”