Historical Trend in the Disparity Implications of Applying Medicare MTM Eligibility Criteria

Background: Minorities have lower likelihood of meeting the eligibility criteria for Medicare medication therapy management (MTM) services than non-Hispanic Whites (Whites). Objective: This study determined whether the MTM eligibility criteria would perform better in the future by examining the historical trend of MTM disparities from 1996-1997 to 2007-2008. Methods: This study analyzed the Medicare beneficiaries from the Medical Expenditure Panel Survey. Proportions and the odds of meeting MTM eligibility criteria were compared between Whites and two minority population, non-Hispanic Blacks (Blacks) and Hispanics using chi-square test and logistic regression. The trend of disparities was examined by including in regression models interaction terms between dummy variables for the minority groups and latter time period. MTM eligibility criteria used by health plans in 2008 and 2010-2011 were examined. Main and sensitivity analyses were conducted to represent the entire range of the eligibility criteria. Results: In the main analysis examining the performance of 2010 eligibility criteria in 1996-1997, the proportions of meeting MTM eligibility criteria among Whites, Blacks, and Hispanics were 5.19%, 3.67%, and 5.43% (p>0.05 for the comparison between Whites and other groups). After adjusting for patient characteristics, Blacks and Hispanics had odds ratios for MTM-eligible of 0.52 (CI: 0.34-0.81) and 0.94 (CI: 0.61-1.44) compared to Whites. No evidence was found to support a change over time in these disparity patterns. Sensitivity analyses and analyses examining 2008 eligibility produced similar findings. Conclusion: Racial disparities in meeting MTM eligibility criteria may not decrease over time unless Medicare MTM eligibility criteria are changed.