Association of low-income subsidy, medicaid dual eligibility, and disability status with high-risk medication use among Medicare Part D beneficiaries

Chanadda Chinthammit, Sandipan Bhattacharjee, Wei Hsuan Lo-Ciganic, David R. Axon, Marion Slack, John P. Bentley, Terri L Warholak

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Low-income subsidy/dual eligibility (LIS/DE) status and disability status may be associated with high-risk medication (HRM) use but are not usually accounted for in medication-use quality measures. Objective: To examine the association of: 1) LIS/DE status and HRM use; and 2) disability status and HRM use, while controlling for both health plan level effects and patient characteristics for Medicare beneficiaries enrolled in Medicare Advantage Prescription Drug Plans (MA-PD) and stand-alone Prescription Drug Plans (PDP). Methods: This retrospective cross-sectional study used 2013 Medicare data to determine if LIS/DE status and disability status were independently associated with HRM use (using the Pharmacy Quality Alliance HRM measure) in MA-PDs and PDPs. Multivariable generalized linear mixed models assessed the association of LIS/DE and HRM use, and disability and HRM use, after adjusting for health plan effect and patient-level confounders for MA-PD and PDP beneficiaries. Results: Of 520,019 MA-PD beneficiaries, 88,693 (17.1%) were LIS/DE and 48,997 (9.4%) were disabled. Of 881,264 PDP beneficiaries, 213,096 (24.2%) were LIS/DE, and 83,593 (9.5%) were disabled. LIS/DE beneficiaries had a higher percent of HRM users compared to non-LIS/DE MA-PD (13.3% vs. 9.7%, p < 0.001) and PDP (17.1% vs. 13.2%, p < 0.001) beneficiaries. Disabled beneficiaries had a higher percent of HRM users compared to non-disabled MA-PD (17.0% vs. 9.6%, p < 0.001) and PDP (22.9% vs. 13.2%, p < 0.001) beneficiaries. Multivariable analyses showed LIS/DE (adjusted odds ratio [AOR] = 1.07; 95% CI = 1.04, 1.10) and disability (AOR = 1.38; 95% CI = 1.34, 1.42) were associated with HRM use among MA-PD and PDP beneficiaries (LIS/DE AOR = 1.14; 95% CI = 1.12, 1.16; disability AOR = 1.37; 95% CI = 1.34, 1.40). Conclusions: The association of LIS/DE and disability with higher HRM use in both MA-PD and PDP beneficiaries, when controlling for health plan effects and patient characteristics, suggests these factors should be considered when comparing health plan performance on HRM measures.

Original languageEnglish (US)
JournalResearch in Social and Administrative Pharmacy
DOIs
StateAccepted/In press - 2021

Keywords

  • Disability
  • High-risk medication
  • Low-income subsidy
  • Medicaid dual eligibility
  • Medicare
  • Quality measures

ASJC Scopus subject areas

  • Pharmacy
  • Pharmaceutical Science

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