Medicare introduced the program, Medication Therapy Management or MTM, in 2006 as part of the Part D prescription drug program. MTM provides face-to-face counseling, phone consultation or consultations by mail with pharmacists or other health care providers to help people with chronic illness resolve problems with taking medications. The goal is to improve patient health, reduce costs and minimize side effects.
In 2010, to be eligible for the program, a person must be enrolled in the Medicare Part D drug program, have at least three chronic health conditions, take eight or more medications covered by Part D and spend at least $3,000 yearly on the medications.
Researchers led by Junling Wang, Ph.D., at the University of Tennessee College of Pharmacy looked at data to see whether African-Americans, Hispanics or whites equally would be apt to meet these eligibility criteria.
“We suspected there might be potential problems related to eligibility criteria for minorities since historically racial and ethnic minorities tend to use fewer medications and they tend to incur lower prescription drug costs,” Wang said. This is despite the fact that minority groups are at higher risk than whites for developing many serious chronic diseases, such as diabetes and heart disease.
The study appears online in the journal Health Services Research.
The researchers found that African-Americans would be up to 34 percent less likely to meet MTM eligibility than whites and that Hispanics would be up to 38 percent less prone to meet eligibility requirements. This pattern held even in those patients with severe health problems.
The findings are important, Wang said, because other health agencies and private insurers often adopt Medicare policies. She also said that recent changes in policies to improve health care quality have not been very effective in reducing racial and ethnic disparities.
“In fact, sometimes these policies have really widened the disparity gap. Minorities historically have different patterns of medication utilization from the majority population. If we don’t take those differences into consideration, minorities will lag behind,” she said.
“You have to be on a lot of drugs or some pretty expensive medications to qualify for MTM services,” said Marissa Schlaifer, pharmacy affairs director at the Academy of Managed Care Pharmacy. “This study does remind us that those people who are not on medications they need are less likely to qualify for MTM services,” because the determining factors are being on multiple drugs and having high drug costs. “People who aren’t getting the drugs they need are just as much in need of MTM services as people who are getting too many drugs.”
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Health Services Research is the official journal of the AcademyHealth and is published by John Wiley & Sons, Inc. on behalf of the Health Research and Educational Trust. For information, contact Jennifer Shaw, HSR Business Manager at (312) 422-2646 or firstname.lastname@example.org. HSR is available online at www.blackwell-synergy.com/loi/hesr.
Wang J, et al. Disparity implications of Medicare eligibility criteria for Medication Therapy Management services. Health Services Research online, 2010.