Potential health implications of medication therapy management eligibility criteria in the patient protection and affordable care act across racial and ethnic groups

Journal of Managed Care Pharmacy

Volumn 21, Issue 11, 2015, Pages 993-1003

  Wang, Junling ^a   Qiao, Yanru ^a   Shih, Ya Chen Tina ^e   Jarrett Jamison, JoEllen ^a   Spivey, Christina A ^a   Wan, Jim Y ^c   White Means, Shelley I ^a   Dagogo Jack, Samuel ^c   Cushman, William C ^c,d   Chisholm Burns, Marie ^b  

^a Economic Empowerment and Research ^*  (United States)

^b UNIVERSITY OF TENNESSEE COLLEGE OF PHARMACY   (United States)

^c UNIVERSITY OF TENNESSEE COLLEGE OF MEDICINE   (United States)

^d VETERANS AFFAIRS MEDICAL CENTER   (United States)

^e UNIVERSITY OF TEXAS MD ANDERSON CANCER CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AGED; ARTICLE; BLACK PERSON; CAUCASIAN; CHRONIC DISEASE; CONTROLLED STUDY; DAILY LIFE ACTIVITY; ETHNIC DIFFERENCE; FEMALE; HEALTH CARE COST; HEALTH CARE DISPARITY; HEALTH CARE POLICY; HEALTH CARE UTILIZATION; HEALTH INSURANCE ELIGIBILITY; HEALTH STATUS; HISPANIC; HUMAN; MAJOR CLINICAL STUDY; MALE; MEDICARE; MEDICATION THERAPY MANAGEMENT; RACE DIFFERENCE; VERY ELDERLY; CROSS-SECTIONAL STUDY; HEALTH CARE SURVEY; MINORITY GROUP; RETROSPECTIVE STUDY; ETHNIC GROUP; ORGANIZATION AND MANAGEMENT; POPULATION GROUP; UNITED STATES;

NON PRESCRIPTION DRUG; PRESCRIPTION DRUG;

AGED; AGED, 80 AND OVER; CROSS-SECTIONAL STUDIES; ELIGIBILITY DETERMINATION; ETHNIC GROUPS; FEMALE; HUMANS; MALE; MEDICARE PART D; MEDICATION THERAPY MANAGEMENT; PATIENT PROTECTION AND AFFORDABLE CARE ACT; POPULATION GROUPS; RETROSPECTIVE STUDIES; UNITED STATES;

EID: 84946415735     PISSN: 10834087     EISSN: None     Source Type: Journal    
DOI: 10.18553/jmcp.2015.21.11.993     Document Type: Article

References (37)

1. Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc (Wash). 2001;41(2):192-99.
2. Petrone K, Katz P. Approaches to appropriate drug prescribing for the older adult. Prim Care. 2005;32(3):755-75.
3. Centers for Medicare&Medicaid Services (CMS), HHS. Medicare program; Medicare prescription drug benefit. Final rule. Fed Regist. 2005;70(18):4193-585.
4. Bunting BA, Smith BH, Sutherland SE. The Asheville Project: clinical and economic outcomes of a community-based long-term medication therapy management program for hypertension and dyslipidemia. J Am Pharm Assoc (2003). 2008;48(1):23-31.
5. Cranor CW, Bunting BA, Christensen DB. The Asheville Project: longterm clinical and economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc (Wash). 2003;43(2):173-84.
6. Etemad LR, Hay JW. Cost-effectiveness analysis of pharmaceutical care in a Medicare drug benefit program. Value Health. 2003;6(4):425-35.
7. Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. JAMA. 2006;296(21):2563-71.
8. Wang J, Mullins CD, Brown LM, et al. Disparity implications of Medicare eligibility criteria for medication therapy management services. Health Serv Res. 2010;45(4):1061-82.
9. Wang J, Qiao Y. Historical trend of disparity implications of Medicare MTM eligibility criteria. Res Social Adm Pharm. 2013;9(6):758-69.
10. Briesacher B, Limcangco R, Gaskin D. Racial and ethnic disparities in prescription coverage and medication use. Health Care Financ Rev. 2003;25(2):63-76.
11. Wang J, Zuckerman IH, Miller NA, Shaya FT, Noel JM, Mullins CM. Utilizing new prescription drugs: disparities among non-Hispanic whites, non-Hispanic blacks, and Hispanic whites. Health Serv Res. 2007;42(4):1499-519.
12. Wang J, Qiao Y, Tina Shih YC, et al. Potential health implications of racial and ethnic disparities in meeting MTM eligibility criteria. Res Social Adm Pharm. 2014;10(1):106-25.
13. Office of the Legislative Counsel. Compilation of Patient Protection and Affordable Care Act (as amended through May 1, 2010). Available at: http://www.leahy.senate.gov/imo/media/doc/Affordable%20Care%20Act%20 Full%20Text.pdf. Accessed September 19, 2015.
14. Centers for Medicare&Medicaid Services. Medicare Current Beneficiary Survey (MCBS). Available at: https://www.cms.gov/Research-Statistics-Data-and-systems/Research/MCBS/index.html?redirect=/MCBS/. Accessed September 19, 2015.
15. U.S. Food and Drug Administration. Orange Book Data Files. Available at: http://www.fda.gov/drugs/informationondrugs/ucm129689.htm. Accessed September 19, 2015.
16. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a U.S. consensus panel of experts. Arch Intern Med. 2003;163(22):2716-24.
17. Daniel GW, Malone DC. Characteristics of older adults who meet the annual prescription drug expenditure threshold for medicare medication therapy management programs. J Manag Care Pharm. 2007;13(2):142-54. Available at: http://amcp.org/data/jmcp/p142-54.pdf.
18. Elixhauser A, Steiner C, Palmer L. Clinical Classifications Software (CCS), 2014. U.S. Agency for Healthcare Research and Quality. Available at: https://www.hcup-us.ahrq.gov/toolssoftware/ccs/CCSUsersGuide.pdf. Accessed September 26, 2015.
19. Gornick ME. The association of race/socioeconomic status and use of Medicare services. A little-known failure in access to care. Ann N Y Acad Sci. 1999;896:497-500.
20. Gornick ME. Disparities in Medicare services: potential causes, plausible explanations, and recommendations. Health Care Financ Rev. 2000;21(4):23-43.
21. Gornick ME, Egers PW, Reilly TW, et al. Effects of race and income on mortality and use of services among Medicare beneficiaries. N Engl J Med. 1996;335(11):791-99.
22. Wang J, Mullins CD, Chang CF, et al. Comparisons of changes over time in health expenditures per capita across racial and ethnic groups. Int J of Public Policy. 2010;6(3/4):172-89.
23. Gerber BS, Cho YI, Arozullah AM, Lee SY. Racial differences in medication adherence: a cross-sectional study of Medicare enrollees. Am J Geriatr Pharmacother. 2010;8(2):136-45.
24. Shi L, Green LH, Kazakova S. Primary care experience and racial disparities in self-reported health status. J Am Board Fam Pract. 2004;17(6):443-52.
25. Ciol MA, Shumway-Cook A, Hoffman JM, Yorkston KM, Dudgeon BJ, Chan L. Minority disparities in disability between Medicare beneficiaries. J Am Geriatr Soc. 2008;56(3):444-53.
26. Liberman JN, Roebuck MC. Prescription drug costs and generic dispensing ratio. J Manag Care Pharm. 2010;16(7):502-06. Available at: http://www. amcp.org/data/jmcp/502-506.pdf.
27. Buis M. Stata tip 87: interpretation of interactions in non-linear models. Available at: http://www.maartenbuis.nl/publications/interactions.pdf. Accessed September 19, 2015.
28. Chernew ME, Shah MR, Wegh A, et al. Impact of decreasing copayments on medication adherence within a disease management environment. Health Aff (Millwood). 2008;27(1):103-12.
29. Bautista RE, Rundle-Gonzalez V. Effects of antiepileptic drug characteristics on medication adherence. Epilepsy Behav. 2012;23(4):437-41.
30. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1-10.
31. Iezzoni L, ed. Risk Adjustment for Measuring Healthcare Outcomes. 2nd ed. Chicago, IL: Health Administration Press; 1997.
32. Centers for Medicare&Medicaid Services. Risk adjustment. Available at: http://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors.html. Accessed September 19, 2015.
33. Koh HK, Graham G, Glied SA. Reducing racial and ethnic disparities: the action plan from the department of health and human services. Health Aff (Millwood). 2011;30(10):1822-29.
34. Weinick RM, Hasnain-Wynia R. Quality improvement efforts under health reform: how to ensure that they help reduce disparities-not increase them. Health Aff (Millwood). 2011;30(10):1837-43.
35. Stuart B, Loh E, Miller L, Roberto P. Should eligibility for medication therapy management be based on drug adherence? J Manag Care Pharm. 2014;20(1):66-75. Available at: http://www.amcp.org/JMCP/2014/January/17497/1033.html.
36. Stuart B, Loh FE, Roberto P, Miller LM. Increasing Medicare part D enrollment in medication therapy management could improve health and lower costs. Health Aff (Millwood). 2013;32(7):1212-20.
37. Medicare program; contract year 2015 policy and technical changes to the Medicare Advantage and the Medicare prescription drug benefit programs. 42 CFR 409, 417, 422, 423, 424 (2014). Available at: http://www.gpo.gov/fdsys/pkg/FR-2014-01-10/pdf/2013-31497.pdf. Accessed September 21, 2015.