Changes in Use of Lipid Lowering Medications among Black and White Dual Enrollees with Diabetes Transitioning from Medicaid to Medicare Part D Drug Coverage
Published Date:Aug 2014
Source:Med Care. 52(8):695-703.
Pubmed Central ID:PMC4135389
Funding:K01 HS018072/HS/AHRQ HHS/United States
P30 DK092924/DK/NIDDK NIH HHS/United States
P30DK092924/DK/NIDDK NIH HHS/United States
R01 AG032249/AG/NIA NIH HHS/United States
R01 DK080726-01/DK/NIDDK NIH HHS/United States
R01 HS018577/HS/AHRQ HHS/United States
R01AG032249/AG/NIA NIH HHS/United States
U58 DP002721/DP/NCCDPHP CDC HHS/United States
The use of lipid lowering agents is suboptimal among dual enrollees, particularly blacks.
To determine whether the removal of restrictive drug caps under Medicare Part D reduced racial differences among dual enrollees with diabetes.
An interrupted time series with comparison series design (ITS) cohort study.
8,895 black and white diabetes ≥18 year old patients 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.
We examined the monthly (1) proportion of patients with any use of lipid lowering therapies and (2) intensity of use. Stratification measures included age (<65, ≥65), race (white vs. black) and gender.
At baseline, lipid lowering drug use was higher in no drug cap states (drug cap: 54.0% vs. non-drug 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% CI: 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.
Medicare Part D was associated with increased use of lipid lowering drugs, but racial gaps persisted. Understanding non-coverage-related barriers is critical to maximizing the potential benefits of coverage expansions for disparities reduction.
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