• Julie Zissimopoulos, Geoffrey F Joyce, Lauren M Scarpati, and Dana P Goldman.
• Schaeffer Center for Health Policy and Economics, University of Southern California, 635 Downey Way, Los Angeles, CA 90089-3331.Tel: 213-821-7947; Fax: 213-740-3460. E-mail: zissimop@usc.edu.
• Am J Manag Care. 2015 Feb 1; 21 (2): 119-28.

ObjectivesWe assessed whether Medicare Part D reduced disparities in access to medication.Study DesignSecondary data analysis of a 20% sample of Medicare beneficiaries, using Parts A and B medical claims from 2002 to 2008 and Part D drug claims from 2006 to 2008.MethodsWe analyzed the medication use of Hispanic, black, and white beneficiaries with diabetes before and after reaching the Part D coverage gap, and compared their use with that of race-specific reference groups not exposed to the loss in coverage. Unadjusted difference-in-difference results were validated with multivariate regression models adjusted for demographics, comorbidities, and zip code-level household income used as a proxy for socioeconomic status.ResultsThe rate at which Hispanics reduced use of diabetes-related medications in the coverage gap was twice as high as whites, while blacks decreased their use of diabetes-related medications by 33% more than whites. The reduction in medication use was correlated with drug price. Hispanics and blacks were more likely than whites to discontinue a therapy after reaching the coverage gap but more likely to resume once coverage restarted. Hispanics without subsidies and living in low-income areas reduced medication use more than similar blacks and whites in the coverage gap.ConclusionsWe found that the Part D coverage gap is particularly disruptive to minorities and those living in low-income areas. The implications of this work suggest that protecting the health of vulnerable groups requires more than premium subsidies. Patient education may be a first step, but more substantive improvements in adherence may require changes in healthcare delivery.

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