Disparity Implications of Proposed 2015 Medicare Eligibility Criteria for Medication Therapy Management Services

Background:  Previous studies found that racial and ethnic minorities were less likely than non-Hispanic Whites (Whites) to meet the eligibility criteria for medication therapy management (MTM) services in Medicare Part D. Mainly to address such disparity issues, the Centers for Medicare & Medicaid Services proposed for 2015 to lower MTM eligibility thresholds. These MTM eligibility criteria were not implemented due to political reasons, but regardless of its implementation or lack thereof, it is not clear whether these new rules would resolve MTM disparity issues. 

Objectives: The study objective was to determine whether there would be racial and ethnic disparities in meeting the proposed 2015 MTM eligibility criteria for Part D. 

Methods: This was a cross-sectional analysis of Medical Expenditure Panel Survey (2010-2011). Proportions of MTM eligibility across racial and ethnic groups were compared using a chi-square test. A logistic regression was used to adjust for population socio-demographic characteristics.

Results: Compared to Whites with a proportion of MTM eligibility of 58.82%, the proportion of eligible non-Hispanic Blacks was similar (57.09%; P=0.20) while the proportion of eligible Hispanics was lower (48.97%; P<0.001). MTM eligibility was lower among minorities according to the multivariate logistic regression: odds ratios of MTM eligibility for Blacks and Hispanics compared to Whites were 0.74 (95% Confidence Internal [CI]: 0.62-0.88) and 0.53 (95% CI = 0.43-0.67), respectively.

Conclusions: The proposed 2015 MTM eligibility criteria seem to be associated with similar racial and ethnic disparities in MTM eligibility as previous MTM eligibility criteria. To promote health equity, decision makers need to develop alternative strategies.