Changes in Use of Lipid Lowering Medications among Black and White Dual Enrollees with Diabetes Transitioning from Medicaid to Medicare Part D Drug Coverage

Details

• Alternative Title:
  Med Care
• Personal Author:
  Adams, Alyce S. ; Madden, Jeanne M. ; Zhang, Fang ; Soumerai, Stephen B. ; Gilden, Dan ; Griggs, Jennifer ; Trinacty, Connie Mah ; Bishop, Christine ; Ross-Degnan, Dennis
• Description:
  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 ; 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. ; 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 (<65, ≥65), race (white vs. black) and gender. ; Results ; 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. ; Conclusions ; 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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• Subjects:
  • Adolescent
  • Adult
  • Black or African American
  • Age Factors
  • Aged
  • Comorbidity
  • Diabetes Mellitus
  • Female
  • Humans
  • Hypolipidemic Agents
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• Source:
  Med Care. 52(8):695-703
• Pubmed ID:
  24988304
• Pubmed Central ID:
  PMC4135389
• Document Type:
  Journal Article
• Funding:
  K01 HS018072/HS/AHRQ HHSUnited States/ ; U58 DP002721/DP/NCCDPHP CDC HHSUnited States/ ; R01 DK080726/DK/NIDDK NIH HHSUnited States/ ; R01 AG032249/AG/NIA NIH HHSUnited States/ ; R01AG032249/AG/NIA NIH HHSUnited States/ ; P30 DK092924/DK/NIDDK NIH HHSUnited States/ ; P30DK092924/DK/NIDDK NIH HHSUnited States/ ; R01 DK080726-01/DK/NIDDK NIH HHSUnited States/
• Volume:
  52
• Issue:
  8
• Download URL:
  https://stacks.cdc.gov/view/cdc/30082/cdc_30082_DS1.pdf
• File Type:
  [PDF - 562.53 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:64cc56027de51b6cfd01ec6f24ad108d1fa227933f6163e202540ca941022552