Open AccessPredictive value positive of MTM eligibility criteria under MMA and ACA in identifying individuals with medication utilization issues
Author(s) -
Qiao Yanru,
Spivey Christina A.,
Wang Junling,
Shih YaChen Tina,
Wan Jim Y.,
Kuhle Julie,
DagogoJack Samuel,
Cushman William C.,
ChisholmBurns Marie
Publication year - 2018
Publication title -
journal of pharmaceutical health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.244
H-Index - 15
eISSN - 1759-8893
pISSN - 1759-8885
DOI - 10.1111/jphs.12266
Subject(s) - medicine , value (mathematics) , predictive value , statistics , mathematics
Objectives To compare the predictive value positives ( PVP ) of medication therapy management eligibility criteria under the Medicare Modernization Act ( MMA ) and Affordable Care Act ( ACA ) in identifying individuals with medication utilization issues ( MUI ). Methods This is a retrospective analysis of Medicare database (2012–2013). MUI were determined based on medication utilization measures related to Medicare Part D Star Ratings. PVP or proportions of individuals with MUI were compared between individuals eligible for medication therapy management ( MTM ) under MMA and ACA . Need‐based and demand‐based logistic regression was used to adjust for patient characteristics. MTM eligibility thresholds in 2009 and 2013 and proposed 2015 MTM eligibility thresholds under MMA were examined. Main/sensitivity/disease‐specific analyses were conducted to cover the range of eligibility thresholds and combinations. Key Findings MMA has higher PVP in identifying patients with MUI than ACA . Proportions of individuals with MUI were higher based on MMA than ACA (e.g. 74.96% for 2009 MMA , 73.51% for 2013 MMA , and 62.46% for proposed 2015 MMA vs. 52.17% for ACA in main analysis; P < 0.05). Adjusted findings were similar. For example, based on the demand‐based model in the main analysis, the odds ratios were 2.474 (95% CI : 2.454–2.494) for 2013 MMA in comparison to ACA . These numbers indicate that the MMA MTM eligibility criteria for 2013 had 147.4% higher PVP in identifying patients with MUI than ACA . Similar patterns were found in most sensitivity and disease‐specific analyses. Conclusions MMA has higher PVP than ACA in identifying patients with MUI . This study may inform the government on future MTM policy.