Racial/ethnic disparities in the enrollment of Medication Therapy Management programs among Medicare beneficiaries with Alzheimer’s disease and related dementias

Abstract

Objective

Previous analysis of policy scenarios reported potential disparities in eligibility in the Medicare Medication Therapy Management (MTM) program. With recently released MTM data, this study aimed to determine if racial/ethnic disparities exist in MTM enrollment among Medicare beneficiaries with Alzheimer’s disease and related dementias (ADRD).

Methods

Medicare claims/records (from 2013–2014 and 2016–2017) linked to the Area Health Resources File were examined. Included individuals were patients with ADRD and diabetes, hypertension or hyperlipidemia. The proportions of MTM enrollment were compared between non-Hispanic White (White) patients and racial/ethnic minority groups in descriptive analysis. Racial/ethnic disparities were then examined using a logistic regression adjusting for patient and community characteristics. Disparities across study periods were compared by estimating a logistic regression model with interaction terms between dummy variables for each racial/ethnic minority group and 2016–2017.

Results

In unadjusted analyses, minorities had higher enrollment proportions than Whites. In 2016–2017, for example, enrollment percentages for Whites, Blacks, Hispanics, Asian/Pacific Islanders (Asians) and Others were respectively 14.44%, 16.71%, 19.83%, 16.66%, and 17.78%. In adjusted analyses, Blacks had lower enrollment odds than Whites within all cohorts. In the entire study sample in 2016–2017, for example, Blacks with ADRD had 9% lower odds of MTM enrollment (odds ratio 0.91, 95% confidence interval [CI] = 0.86–0.97) than Whites. These disparities decreased over time among the ADRD sample and all sub-groups. The interaction term between Blacks and 2016–2017, for instance, indicated that disparities were lowered by 11% (odds ratio 1.11, 95% CI = 1.05–1.16) across study periods among those with ADRD.

Conclusions

Blacks with ADRD, and diabetes, hypertension or hyperlipidemia have lower likelihood of MTM enrollment than Whites. Racial disparities were reduced over time but not eliminated.

Keywords:

• Medication therapy management
• Alzheimer’s
• disparities
• Medicare

Transparency

Declaration of funding

Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG040146. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Declaration of financial/other relationships

M.A.C.-B. has disclosed that she received funding from Carlos and Marguerite Mason Trust. J.W. has disclosed that she received funding from AbbVie, Curo, Bristol Myers Squibb, Pfizer, and Pharmaceutical Research and Manufacturers of America (PhRMA), and serves on the Health Outcomes Research Advisor Committee of the PhRMA Foundation. No potential conflict of interest was reported by J.A.B., C.C.S.T., R.Z., X.D., J.G., J.Y.W., C.K.F. or J.W.T. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

J.A.B.: concept and design, analysis and interpretation of data, and writing (original draft and editing). C.C.S.T.: concept and design, analysis and interpretation of data, and writing (original draft and editing). X.D.: concept and design, analysis and interpretation of data, and writing (original draft and editing). J.G.: concept and design, analysis and interpretation of data, and writing (original draft and editing). R.Z.: analysis and interpretation of data and writing (original draft and editing). J.Y.W.: funding acquisition, concept and design, analysis and interpretation of data, and writing (original draft and editing). M.A.C.-B.: funding acquisition, concept and design, analysis and interpretation of data, and writing (original draft and editing). C.K.F.: funding acquisition, concept and design, analysis and interpretation of data, and writing (original draft and editing). J.W.T.: funding acquisition, concept and design, analysis and interpretation of data, and writing (original draft and editing). J.W.: funding acquisition, concept and design, analysis and interpretation of data, writing (original draft and editing), and project administration. All authors read and approved the final manuscript.

Acknowledgements

The authors would like to acknowledge assistance with the formatting of the final manuscript from Lorraine Todor and Hannah Foster, Doctor of Pharmacy Students at the University of Tennessee Health Science Center College of Pharmacy.

Data availability statement

The Medicare data were accessed through virtual access to the CMS Virtual Research Data Center.