Disparity implications of Medicare eligibility criteria for medication therapy management services

Abstract

Objective: To determine whether there would be racial and ethnic disparities in meeting eligibility criteria for medication therapy management (MTM) services implemented in 2006 for Medicare beneficiaries.

Data sources/study setting: Secondary data analyses of the Medical Expenditure Panel Survey (2004-2005).

Study design: Logistic regression and recycled predictions were used to test the disparities in meeting eligibility criteria across racial and ethnic groups. The eligibility thresholds used by health plans in 2006 and new thresholds recommended for 2010 were examined. Racial and ethnic disparities were examined by comparing non-Hispanic blacks (blacks) with non-Hispanic whites (whites) and comparing Hispanics with whites, respectively. Disparities were also examined among individuals with severe health problems.

Principal findings: According to 2006 thresholds, the adjusted odds ratios for meeting eligibility criteria for blacks and Hispanics to whites were 0.36-0.60 (p<.05) and 0.13-0.46 (p<.05), respectively. Blacks and Hispanics would be 21-34 and 32-38 percent, respectively, less likely to be eligible than whites according to recycled predictions. Similar patterns were found using the 2010 eligibility thresholds and among individuals with severe health problems.

Conclusions: There would be racial and ethnic disparities in meeting MTM eligibility criteria. Future research is warranted to confirm the findings using data after MTM implementation.

Figure 1

Adjusted Odds Ratios of Medication Therapy Management Eligibility Fulfillment for Non-Hispanic Blacks to Non-Hispanic Whites According to Eligibility Thresholds in 2006 (Each Line Represents a Different Threshold Based on the Number of Chronic Conditions)

Figure 2

Adjusted Odds Ratios of Medication Therapy Management Eligibility Fulfillment for Hispanics to Non-Hispanic Whites According to Eligibility Thresholds in 2006 (Each Line Represents a Different Threshold Based on the Number of Chronic Conditions)