Disparity implications of MTM eligibility criteria

Background: Starting from 2006, the Centers for Medicare and Medicaid Services have required prescription drug (Part D) plans for Medicare beneficiaries to establish medication therapy management (MTM) programs. MTM services are particularly beneficial for patients with chronic diseases and the prevalence of some chronic diseases is higher in minority populations than in non-Hispanic Whites (Whites), including the prevalence of poor disease control, so MTM services could be an important tool for reducing outcome disparities. However, Part D plans are required to provide these services only to Medicare Part D beneficiaries meeting three criteria: having multiple chronic conditions, using multiple Part D drugs, and being likely to incur annual costs for covered Part D drugs that exceed $4,000. Recently, programs other than Medicare have also started providing MTM services using similar eligibility criteria for Medicare. Our recently published analyses of historical data demonstrated that racial and ethnic minorities would be less likely to be eligible for MTM services than Whites. Objective: This study aimed to examine whether racial and ethnic minorities are less likely to qualify for MTM services than Whites among individuals with health insurance other than Medicare beneficiaries. Methods: Our data source was the Medical Expenditure Panel Survey (2006-2007). We examined racial and ethnic disparities separately by comparing non-Hispanic Blacks (Blacks) with Whites, and comparing Hispanics with Whites, respectively. Multivariate survey-weighted logistic regression was used to adjust for possible differences in sociodemographic and health-related characteristics between groups. We studied disparity patterns among two subgroups, individuals in Medicaid and individuals with private insurance. We examined both 2006-2007 MTM eligibility thresholds and 2010 thresholds. Results: Among Medicaid group, the odds ratios for meeting the MTM eligibility criteria for Blacks, compared to Whites, ranged from 0.44 to 0.60. Odds ratios for Hispanics ranged from 0.22 to 0.56. Most odds ratios were statistically significant (p<0.05). Among individuals with private insurance, there was not sufficient statistical evidence that the probabilities of meeting MTM eligibility criteria for Blacks and Whites differed. However, compared to Whites, odds ratios for Hispanics ranged from 0.45 to 0.61. Most odds ratios were statistically significant (p<0.05). Conclusion: Blacks and Hispanics are less likely to qualify for MTM services than Whites among individuals with Medicaid. Hispanics are less likely to quality for MTM eligibility criteria than Whites among individuals with private insurance. Decision-makers need to be cautious about the disparity implications when determining eligibility criteria.