Racial differences in switching, augmentation, and titration of lipid-lowering agents by Medicare/Medicaid dual-eligible patients

Abstract

RESEARCH OBJECTIVE:
The goal of this study was to examine prescription fill patterns of lipid-lowering agents among Medicare/ Medicaid dual-eligible patients by ethnicity.
DATA AND METHODS:
Study data were obtained from the Thomson Medstat MarketScan Medicaid claims database. Medicare/Medicaid beneficiaries who filled prescriptions for lipid-lowering agents during 2003 were included in the study. Logistic regression models estimated the probability that beneficiaries, by ethnicity, switched to a different lipid-lowering medication, augmented therapy with another lipid-lowering agent, or titrated the dosage of the drug upward over the course of the year.
RESULTS:
The models revealed that African Americans were less likely to switch lipid-lowering agents (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.60-0.78), augment lipid-lowering agents (OR, 0.53; 95% CI, 0.43-0.66), or titrate upward (OR, 0.75; 95% CI, 0.67-0.84) than whites.
CONCLUSION:
These results suggest that African Americans may be receiving less aggressive treatment than other patients, which in turn may explain why many studies find that African Americans are less likely to reach lipid goals. These treatment disparities merit further study, because they may impact dual-eligible patients moving into Medicare Part D plans.