206818 Disparity implications of utilization-based eligibility criteria for medication therapy management services

Tuesday, November 10, 2009: 8:45 AM

Junling Wang, PhD , Department of Pharmaceutical Sciences, University of Tennessee, Memphis, TN
C. Daniel Mullins, PhD , Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD
Song Hee Hong, PhD , Department of Pharmaceutical Sciences, School of Pharmacy, University of Tennessee, Memphis, TN
Lawrence Brown , Department of Pharmaceutical Sciences, University of Tennessee, Memphis, TN
Ya-Chen Shih , Department of Statistics, University of Texas M.D. Anderson Cancer Center, Houston, TX
Samuel Dagogo-Jack , Department of Medicine, University of Tennessee, Memphis, TN
William Cushman , Department of Preventive Medicine and Medicine, University of Tennessee, Memphis, TN
Background: Since January 1, 2006, the Centers for Medicare and Medicaid Services have required prescription drug plans to offer medication therapy management services (MTMS) for Medicare Part D beneficiaries meeting three criteria: having multiple chronic conditions, using multiple covered drugs, and/or being likely to incur over $4,000 (in 2006 dollars) in annual drug costs. Racial and ethnic minorities may be less likely to qualify for MTMS according to these utilization-based criteria since minorities tend to use fewer drugs than their majority counterparts.

Methods: Using the Medical Expenditure Panel Survey (2004-2005) and logistic regression, we examined whether there would be disparities in eligibility fulfillment for any possible combinations of the three MTMS criteria among Medicare beneficiaries. Racial and ethnic disparities were examined by comparing non-Hispanic blacks with non-Hispanic whites, and comparing Hispanic whites with non-Hispanic whites, respectively. Multivariate logistic regression was used to adjust for possible differences in sociodemographic characteristics between groups. The eligibility thresholds used were $4,000 in 2006 dollars, 3 medical conditions and/or 6 drugs. Sensitivity analyses were conducted using variations of these thresholds.

Results: Among Medicare beneficiaries, the odds ratios for meeting the eligibility criteria for non-Hispanic blacks, compared to non-Hispanic whites, ranged from 0.191 to 0.813. Odds ratios for Hispanic whites ranged from 0.054 to 0.775. Most odds ratios were statistically significant (p<0.05).

Conclusion: Non-Hispanic blacks and Hispanic whites would be less likely to qualify for MTMS than non-Hispanic whites. Decision-makers need to be cautions when determining eligibility criteria.

Learning Objectives:
1. Evaluate the disparity implications for the eligibility criteria for medication therapy management services. 2. Demonstrate a method to quantitatively determine whether there are racial and ethnic disparities in meeting eligibility criteria for health services. 3. Identify eligibility criteria for health services that might have disparity implications.

Keywords: Access and Services, Access to Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal investigator for this research project.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.