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Changes in Use of Lipid Lowering Medications among Black and White Dual Enrollees with Diabetes Transitioning from Medicaid to Medicare Part D Drug Coverage
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8 2014
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Source: Med Care. 52(8):695-703
[PDF-562.53 KB]
Details:
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Alternative Title:Med Care
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Personal Author:
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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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Pubmed ID:24988304
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Pubmed Central ID:PMC4135389
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