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Medical Care:
doi: 10.1097/MLR.0000000000000159
Original Articles

Changes in Use of Lipid-lowering Medications Among Black and White Dual Enrollees With Diabetes Transitioning From Medicaid to Medicare Part D Drug Coverage

Adams, Alyce S. PhD*; Madden, Jeanne M. PhD; Zhang, Fang PhD; Soumerai, Stephen B. ScD; Gilden, Dan MS; Griggs, Jennifer MD§; Trinacty, Connie M. PhD; Bishop, Christine PhD; Ross-Degnan, Dennis ScD

Supplemental Author Material
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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.

© 2014 by Lippincott Williams & Wilkins.

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