Effects of Medicare Part D medication therapy management on racial/ethnic disparities in adherence to antidementia medications among patients with Alzheimer’s disease and related dementias: An observational study

Abstract

Abstract Background Evidence is sparse on the effects of Medicare medication therapy management on racial/ethnic disparities in medication adherence among patients with Alzheimer’s disease and related dementias. The objective of this study was to examine the Medicare medication therapy management program’s effects on racial/ethnic disparities in the adherence to antidementia medications among patients with Alzheimer’s disease and related dementias. Methods This is a retrospective analysis of 2016 and 2017 Medicare Parts A, B, and D data linked to Area Health Resources Files. The study outcome was nonadherence to antidementia medications, and intervention was defined as new medication therapy management enrollment in 2017. Propensity score matching was conducted to create intervention and comparison groups with comparable characteristics. A difference-in-differences model was employed with a logistic regression, including interaction terms of dummy variables for the intervention group and racial/ethnic minorities. Results Unadjusted comparisons revealed that Black, Hispanic, and Asian/Pacific Islander (Asian) patients were more likely to be nonadherent than non-Hispanic White (White) patients in 2016. Differences in odds of nonadherence between Black and White patients were lower in 2017 than in 2016 by 27% (odds ratios [OR]: 0.73, 95% confidence interval [CI]: 0.65–0.82). The same difference was also lower between Hispanic and White patients by 26% (OR: 0.74, 95% CI: 0.63–0.87). The MTM enrollment was associated with reduced disparities for Black-White patients of 33% (OR: 0.67, 95% CI: 0.57–0.78) and Hispanic-White patients of 19% (OR: 0.81, 95% CI: 0.67–0.99). Conclusions Medicare medication therapy management program was associated with lower disparities between Black and Hispanic patients with Alzheimer’s disease and related dementias than their White counterparts. Expanding the medication therapy management program may particularly benefit racial/ethnic minorities in Alzheimer’s disease and related dementias care.