The University of Tennessee Health Science Center’s (UTHSC) Junling Wang, PhD, professor in the Department of Clinical Pharmacy and Translational Science, has been awarded over $1.4 million from the National Institutes of Health (NIH) to further her research on the equity and economic effects of medication management therapy programs. Her project titled, “Equity and Economic Effects of MTM Services,” is being funded for four years.
Drug-related morbidity and mortality cost the United States over $177.4 billion annually and these figures are especially concerning among the elderly. The Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) established medication management therapy (MTM) programs in 2006 to be administered by health care providers, including pharmacists, as a part of the federal health insurance prescription drug program Medicare Part D. The program aims to address medication utilization issues commonly experienced by older adults, while also ensuring the best therapeutic outcomes and reducing costs.
“Unfortunately, enrollment has fallen below CMS targets mainly due to issues in the program’s design,” Dr. Wang said. “Based on our previous analysis of policy scenarios, the eligibility criteria for medication management therapy programs may be too restrictive for racial/ethnic minorities because MTM eligibility is predominantly based on utilization of medications and health services, which minorities tend to use less. Further, we found that MTM eligibility criteria may perpetuate racial/ethnic disparities in health outcomes.”
A critical barrier to effective medication management therapy reform is the lack of stronger information about the actual effects of MTM programs on minorities’ outcomes, utilization of MTM programs by minorities, and the cost-effectiveness of MTM programs. Using newly-released Medicare Parts A/B/D data, Dr. Wang and her co-investigators aim to provide stronger information to guide medication management therapy policymaking by the Centers for Medicare and Medicaid Services.
“We will first test whether MTM programs have reduced racial/ethnic disparities in medication utilization, utilization and/or cost of health services (such as physician visits emergency room visits, and hospitalizations), and mortality,” Dr. Wang said. “We will also test whether non-Hispanic blacks and Hispanics receive fewer and delayed MTM services than whites. Finally, we will determine the cost-effectiveness of the MTM program from the perspectives of Medicare and the health system.”
Dr. Wang advises the outcomes of this study could “provide the NIH with much-needed empirical evidence to strategically advise CMS on policy decisions,” potentially affecting millions of people across the U.S.
“Our project can help to improve the health status of older adults in diverse populations by improving medication utilization and reducing racial/ethnic disparities in medication utilization and health outcomes,” Dr. Wang said. “I am amazed that we get to do this important work.”
Dr. Wang’s co-investigators on the study include Marie A. Chisholm-Burns, PharmD, MPH, MBA, FCCP, FASHP, dean and professor in the UTHSC College of Pharmacy; Jim Y. Wan, PhD, professor in the Department of Preventive Medicine at UTHSC; Samuel Dagogo-Jack, MD, FRCP, A. C. Mullins Professor in Translational Research, professor of Medicine, director of the Division of Endocrinology, Diabetes and Metabolism, and director of Clinical Research Center at UTHSC; William C. Cushman, MD, professor in the Departments of Preventive Medicine, Medicine, and Physiology in the College of Medicine at UTHSC and chief, Preventive Medicine Section at the Memphis VA Medical Center; Lisa E. Hines, PharmD, vice president of Performance Measurement and Operations at Pharmacy Quality Alliance in Alexandria, Virginia; and Ya-Chen Tina Shih, PhD, professor and chief, Section of Cancer Economics and Policy in the Department of Health Services Research at the University of Texas MD Anderson Cancer Center in Houston. Yanru Qiao, MS, is the data analyst on the team.