title: Historical trend of racial and ethnic disparities in meeting Medicare medication therapy management eligibility in non-Medicare population.
abstract: BACKGROUND
  Prior research examining racial and ethnic disparities in meeting Medicare medication therapy management (MTM) eligibility criteria among the non-Medicare population suggests minorities have lower likelihood of being eligible than non-Hispanic Whites (Whites). However, such research has not examined trends in disparities and whether these disparities may be expected to decrease over time based on historical data.
  
  
  OBJECTIVE
  To examine trends in MTM eligibility disparities among the non-Medicare population from 1996-1997 to 2009-2010.
  
  
  METHODS
  This retrospective observational analysis used Medical Expenditure Panel Survey data from the two study periods. The MTM eligibility criteria used by health insurance plans in 2008 and 2010 were analyzed. Trends in disparities were examined by including interaction terms between dummy variables for 2009-2010 and non-Hispanic Blacks (Blacks)/Hispanics in a logistic regression. Interaction effects were estimated on both the multiplicative and additive terms. Main and sensitivity analyses were conducted to represent the ranges of the Medicare MTM eligibility thresholds used by health insurance plans.
  
  
  RESULTS
  According to the main analysis, Blacks and Hispanics were less likely to be eligible than Whites for both sets of eligibility criteria in 1996-1997 and in 2009-2010. Trend analysis for both sets of criteria found that on the multiplicative term, there were generally no significant changes in disparities between Whites and Blacks/Hispanics from 1996-1997 to 2009-2010. Interaction on the additive term found evidence that disparities between Whites and Blacks/Hispanics may have increased from 1996-1997 to 2009-2010 (e.g., in the main analysis between Whites and Hispanics for 2010 eligibility criteria: difference in odds = -0.03, 95% CI: [-0.03]-[-0.02]).
  
  
  CONCLUSIONS
  Racial and ethnic minorities in the non-Medicare population experience persistent and often increasing disparities in meeting MTM eligibility criteria. Drug benefit plans should take caution when using elements of Medicare MTM eligibility criteria.
authors.affiliation: Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis, TN, USA. Electronic address: jwang26@uthsc.edu.
authors.forename: Junling
authors.initials: J
authors.lastname: Wang
authors.affiliation: University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Satya
authors.initials: S
authors.lastname: Surbhi
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Zhiping
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis, TN, USA.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Spivey
authors.affiliation: University of Tennessee College of Pharmacy, Memphis, TN, USA.
authors.forename: Marie
authors.initials: M
authors.lastname: Chisholm-Burns
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People / Q000706:statistics & numerical data*; D004608:Eligibility Determination; D005260:Female; D054625:Healthcare Disparities / Q000639:trends*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D054539:Medication Therapy Management / Q000639:trends*; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult; D001741:Black or African American
keywords: Disparities; Eligibility; Medicare; Medication therapy management services; Non-Medicare