The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) implemented in 2006 by the Centers for Medicare and Medicaid Services (CMS) requires prescription drug (Part D) plans for Medicare beneficiaries to establish medication therapy management (MTM) programs with a purpose to "optimize therapeutic outcomes ... by improving medication use and reducing adverse events..." MTM services are particularly beneficial for patients with chronic diseases, in whose management pharmacotherapy plays a major role, such as hypertension and diabetes, and especially the elderly. Because the prevalence of these diseases and prevalence of poor control of them are higher in racial and ethnic minorities than Whites, MTM could be an important tool for reducing these disparities. However, our recently published analyses of historical data demonstrate that racial and ethnic minorities would be less likely to be eligible for MTM than Whites. This result is not surprising considering that MTM eligibility criteria are based predominantly on previous drug utilization and costs, and racial and ethnic minorities historically tend to use fewer prescription drugs and incur lower prescription drug costs than do Whites. To understand the health implications of MTM eligibility criteria for minorities, we propose to address whether the racial and ethnic disparities in health status, health services utilization and costs, and medication utilization patterns among MTM-eligible individuals are different from the disparities among MTM-ineligible individuals. This is an important question because greater disparities among MTM-ineligible individuals would suggest that the MTM eligibility criteria have the potential to aggravate racial and ethnic disparities. It is important to include as study outcomes health status, health services utilization and costs, and medication utilization patterns, because the 2010 Patient Protection and Affordability Care Act (PPACA) and the existing literature identified improvements of these aspects as outcomes to achieve through providing MTM services. Racial and ethnic disparities in all these aspects have also been reported. The National Institute on Aging has identified racial and ethnic disparities among Medicare beneficiaries as a funding priority.
Our Specific Aim i s to compare, using the Medicare Current Beneficiary Survey linked to Medicare claims records, racial and ethnic disparities in study outcomes among MTM-eligible and MTM- ineligible Medicare beneficiaries based on various government regulations and policies. We will analyze policy scenarios by using data from before and after Part D implementation, comparing 2004-2005 and 2007-2008 relative to changes from 2001-2002 to 2004-2005, and determine the impact of the MTM eligibility criteria laid out in MMA and PPACA. We will use a variety of multivariate modeling techniques. Because our pilot data already showed greater racial disparities in health status among the MTM-ineligible than the MTM-eligible, this study is highly likely to produce meaningful results. Our long-term goal is to determine the types of government policies and congressional legislations that can reduce disparities.
The National Institute on Aging has identified racial and ethnic disparities among Medicare beneficiaries as a funding priority. This research project assesses the impact of Federal policies on medication therapy management services for Medicare beneficiaries in terms of racial and ethnic disparities in health status, health services utilization and costs, medication utilization patterns, and the implications for disparities in therapeutic outcomes.
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