Effects of medicare part d on disparity implications of medication therapy management eligibility criteria.

The Medicare Part D program was implemented in 2006 according to the Medicare Prescription Drug, Improvement, and Modernization Act (MMA).1 Medication therapy management (MTM) services were established by the Centers for Medicare & Medicaid Services (CMS) as part of the Part D benefit. MTM services may be furnished by a pharmacist or by other healthcare providers to “ensure that covered Part D drugs prescribed to targeted beneficiaries…are appropriately used to optimize therapeutic outcomes.”1 The core components of MTM are the formulation of a medication treatment plan and integration of the plan with all health services provided to patients.2 In consideration of limited resources, the MMA restricted MTM services to Medicare beneficiaries meeting all 3 criteria, including (1) having multiple chronic conditions, (2) using multiple Part D drugs, and (3) being likely to exceed a drug cost threshold of $4000.1,3 For the year 2010 and onward, CMS required the eligibility thresholds to be lowered to no more than 3 chronic conditions, 8 drugs, and $3000 in annual drug costs.3 Of note, 2 of the 3 eligibility criteria depend significantly on the utilization of medications by the beneficiary, whereas multiple studies on medication use patterns have shown that racial and ethnic minorities use fewer medications and incur lower drug costs compared with nonminorities.4–9 Therefore, as Wang and colleagues have found, minorities may be less likely to meet the Medicare MTM eligibility criteria.10 Furthermore, in a recent study, Wang and colleagues found that non-Hispanic blacks and Hispanics were less likely than non-Hispanic whites to report self-perceived good health status, and that there were greater racial and ethnic disparities among the MTM-ineligible than MTM-eligible beneficiary population before the implementation of Part D based on the 2006 and 2010 MTM eligibility criteria.11 This suggests that MTM eligibility criteria perpetuate the existing racial and ethnic disparities in health status. The purpose of this present study was to determine the effects of Part D implementation on the health implications of Medicare MTM eligibility across racial and ethnic groups. If this study found that Part D implementation was not associated with reductions in greater racial and ethnic disparities in the MTM-ineligible than the MTM-eligible individuals, the urgency for modifying MTM eligibility criteria would be even greater than established by the previous studies by Wang and colleagues.10,11