title: Changes in use of lipid-lowering medications among black and white dual enrollees with diabetes transitioning from Medicaid to Medicare Part D drug coverage.
abstract: BACKGROUND
  The use of lipid-lowering agents is suboptimal among dual enrollees, particularly blacks.
  
  
  OBJECTIVE
  To determine whether the removal of restrictive drug caps under Medicare Part D reduced racial differences among dual enrollees with diabetes.
  
  
  METHODS
  An interrupted time series with comparison series design (ITS) cohort study.
  
  
  METHODS
  A total of 8895 black and white diabetes patients aged 18 years and older drawn from a nationally representative sample of fee-for-service dual enrollees (January 2004-December 2007) in states with and without drug caps before Part D.
  
  
  METHODS
  We examined the monthly (1) proportion of patients with any use of lipid-lowering therapies; and (2) intensity of use. Stratification measures included age (less than 65, 65 y and older), race (white vs. black), and sex.
  
  
  RESULTS
  At baseline, lipid-lowering drug use was higher in no drug cap states (drug cap: 54.0% vs. nondrug cap: 66.8%) and among whites versus blacks (drug cap: 58.5% vs. 44.9%, no drug cap: 68.4% vs. 61.9%). In strict drug cap states only, Part D was associated with an increase in the proportion with any use [nonelderly: +0.07 absolute percentage points (95% confidence interval, 0.06-0.09), P<0.001; elderly: +0.08 (0.06-0.10), P<0.001] regardless of race. However, we found no evidence of a change in the white-black gap in the proportion of users despite the removal of a significant financial barrier.
  
  
  CONCLUSIONS
  Medicare Part D was associated with increased use of lipid-lowering drugs, but racial gaps persisted. Understanding non-coverage-related barriers is critical in maximizing the potential benefits of coverage expansions for disparities reduction.
authors.affiliation: *Division of Research, Kaiser Permanente, Oakland, CA †Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA ‡Jen Associates Inc., Cambridge, MA §Department of Internal Medicine, University of Michigan, Ann Arbor, MI ∥Kaiser Permanente Center for Health Research, Honolulu, HI ¶The Heller School for Social Policy and Management, Brandeis University, Waltham, MA.
authors.forename: Alyce S
authors.initials: AS
authors.lastname: Adams
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Madden
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
authors.forename: Dan
authors.initials: D
authors.lastname: Gilden
authors.forename: Jennifer
authors.initials: J
authors.lastname: Griggs
authors.forename: Connie M
authors.initials: CM
authors.lastname: Trinacty
authors.forename: Christine
authors.initials: C
authors.lastname: Bishop
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000208:ethnology; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage* / Q000191:economics; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D054524:Medicare Part D / Q000706:statistics & numerical data*; D008875:Middle Aged; D019338:Polypharmacy; D012737:Sex Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000960:Hypolipidemic Agents