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. 2014 Aug;52(8):695-703.
doi: 10.1097/MLR.0000000000000159.

Changes in use of lipid-lowering medications among black and white dual enrollees with diabetes transitioning from Medicaid to Medicare Part D drug coverage

Alyce S Adams  1 , Jeanne M Madden, Fang Zhang, Stephen B Soumerai, Dan Gilden, Jennifer Griggs, Connie M Trinacty, Christine Bishop, Dennis Ross-Degnan
Affiliations

Changes in use of lipid-lowering medications among black and white dual enrollees with diabetes transitioning from Medicaid to Medicare Part D drug coverage

Alyce S Adams et al. Med Care. 2014 Aug.

Abstract

Background: The use of lipid-lowering agents is suboptimal among dual enrollees, particularly blacks.

Objectives: To determine whether the removal of restrictive drug caps under Medicare Part D reduced racial differences among dual enrollees with diabetes.

Research design: An interrupted time series with comparison series design (ITS) cohort study.

Subjects: 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.

Measures: 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.

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Figures

Figure 1
Figure 1
Cohort Selection Criteria
Figure 2
Figure 2. Time Series of the Proportion with Any Use of Lipid Lowering Medications, 2004–2007
A.) Non-eldery (Age < 65) Strict drug cap states Actual proportion of users, solid black circles Estimated proportion of users per month, solid black line Projected proportion of users per month, dotted black line B.) Elderly (Age ≥ 65) No drug cap states Actual proportion of users, solid grey circles Estimated proportion of users per month, solid grey line Projected proportion of users per month, dotted grey line
See this image and copyright information in PMC

References

    1. Medicare Payment Advisory Commission. [Accessed August 15, 2013.];Chapter 3: Dual eligible beneficiaries: An overview. 2004 Available at: http://www.medpac.gov/publications/congressional_reports/June04_Ch3.pdf.
    1. The Henry J. Kaiser Family Foundation. [Accessed September 15, 2009.];Dual Eligibles: Medicaid’s Role for Low-Income Medicare Beneficiaries. 2006 Available at: www.kff.org/medicaid/upload/4091_06.pdf.
    1. Jiang HJ, Wier LM, Potter DEB, Burgess J. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet] Rockville (MD): Agency for Health Care Policy and Research (US); 2006 Feb – 2010 Sep. Potentially Preventable Hospitalizations among Medicare-Medicaid Dual Eligibles, 2008: Statistical Brief #96. - PubMed
    1. Howard DL, Hakeem FB, Njue C, et al. Racially disproportionate admission rates for ambulatory care sensitive conditions in North Carolina. Public Health Rep. 2007 May-Jun;122:362–72. - PMC - PubMed
    1. Jiang HJ, Andrews R, Stryer D, et al. Racial/ethnic disparities in potentially preventable readmissions: the case of diabetes. Am J Public Health. 2005 Sep;95:1561–7. - PMC - PubMed

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