Trends in delivery of comprehensive medication reviews by race and ethnicity, 2013-2021

Abstract

Background: Comprehensive medication reviews (CMRs) are a cornerstone of medication therapy management (MTM) for millions of Medicare Part D beneficiaries, designed to optimize medication use and health outcomes. However, uptake is inconsistent, with known disparities affecting groups such as Asian, Black, and Hispanic patients. Objective: To evaluate CMR trends from 2013 to 2021, analyzing changes in provider types, delivery methods, and recipients, with a particular focus on variations across Asian, Black, Hispanic, and White beneficiaries. Methods: Employing a serial cross-sectional design, we analyzed Part D MTM program data submitted to the Centers for Medicare & Medicaid Services (CMS) from 2013 through 2021, covering all MTM-eligible Medicare beneficiaries. To explore differences based on race and ethnicity, this dataset was linked with a 5% random sample of Medicare fee-for-service beneficiaries. Descriptive statistics were used to evaluate year-over-year trends in CMR provider categories, the methods of service delivery, and the individuals who received the CMR. Results: The volume of completed CMRs expanded more than 4-fold, increasing from 526,150 encounters in 2013 to more than 2 million by 2020, before a slight decrease in 2021. The proportion of CMRs delivered by plan or pharmacy benefit manager pharmacists declined from 40% in 2013 to 29% in 2021, and the share of reviews provided by MTM vendors and other pharmacist categories generally increased over the same period. Telephone consultations, already the primary mode of delivery, increased their share from 86% to 96% of all CMRs, whereas face-to-face services correspondingly decreased from 14% to 4% across all racial groups. The decline in face-to-face services was steepest for Asian (from 18% in 2013 to 7% by 2021) and Hispanic patients (from 18% in 2013 to 3% by 2021). Black individuals consistently had the highest rates of direct beneficiary involvement (88% in 2021) and the lowest caregiver use. Conclusions: The substantial growth in CMR services represents a positive development in patient care. Nevertheless, the marked shifts toward telephonic delivery and changes in the types of providers and recipients engaged highlight a critical need for ongoing assessment.