JAMA network open · 2026
Racial and Ethnic Disparities in Medication Adherence Among Medicare Advantage Enrollees With Diabetes.
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Essien Utibe R, Roberts Eric T, Ruggiero Dominic A, Tang Jasmyn J, Raghava Sindhu, Ayanian John Z, Tipirneni Renuka
Аннотация
IMPORTANCE: Appropriate medication management can prevent adverse outcomes, yet medication nonadherence remains common, including among patients with diabetes.
OBJECTIVE: To examine racial and ethnic disparities in medication adherence among Medicare Advantage (MA) enrollees with diabetes and assess factors contributing to these disparities.
DESIGN, SETTING, AND PARTICIPANTS: Using the Medicare Master Beneficiary Summary File and MA encounter data, this cohort study included MA enrollees with Part D coverage in 2019 and a documented diabetes diagnosis from January 1, 2017, to December 31, 2018, who filled at least 1 prescription for metformin, insulin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, or a glucagon-like peptide-1 receptor agonist (GLP-1 RA) in 2019. Analysis was conducted between December 2024 and November 2025.
MAIN OUTCOMES AND MEASURES: Unadjusted and adjusted disparities in adherence (proportion of days covered ≥80%) during 2019 were examined for insulin, metformin, and SGLT2 inhibitors and/or GLP-1 RAs, distinguishing within-plan disparities from differences between plans serving proportionately more vs fewer Black or Hispanic enrollees. Oaxaca-Blinder decomposition analysis estimated the contribution of covariates to adherence disparities.
RESULTS: Among 587 716 total beneficiaries (mean [SD] age, 72.11 [8.85] years), analyses of disparities between Black and White enrollees included 80 586 Black (63.3% female) and 233 505 White (50.9% male) beneficiaries; analyses of disparities between Hispanic and White enrollees included 83 116 Hispanic (53.9% female) and 190 509 White (51.1% male) beneficiaries. In unadjusted analyses, adherence was lower among Black beneficiaries than among White beneficiaries: -9.0 percentage points [pp] for SGLT2 inhibitors and/or GLP-1 RAs, -8.0 pp for insulin, and -10.5 pp for metformin (all P < .001). Adherence was also lower among Hispanic beneficiaries than among White beneficiaries: -8.1 pp for SGLT2 inhibitors and/or GLP-1 RAs, -2.8 pp for insulin, and -3.6 pp for metformin (all P < .001). By medication type, within-plan disparities accounted for 74.6% to 85.3% of adherence disparities between Black and White enrollees and 39.1% to 66.1% of disparities between Hispanic and White enrollees. Medicaid or Low-Income Subsidy enrollment was associated with reductions in disparities between Black and White enrollees (22.0% for insulin and 32.3% for SGLT2 inhibitors and/or GLP-1 RAs) and Hispanic and White enrollees (63.9% for insulin and 41.3% for SGLT2 inhibitors and/or GLP-1 RAs).
CONCLUSIONS AND RELEVANCE: This retrospective cohort study of MA enrollees with diabetes found racial and ethnic disparities in diabetes medication adherence. Disparities in adherence to insulin or SGLT2 inhibitors and/or GLP-1 RAs were partially mitigated by Medicaid and prescription drug subsidies but less so by plan-level factors. The findings suggest that additional insurance- and community-level strategies are needed to improve medication adherence among disadvantaged patients and communities.
OBJECTIVE: To examine racial and ethnic disparities in medication adherence among Medicare Advantage (MA) enrollees with diabetes and assess factors contributing to these disparities.
DESIGN, SETTING, AND PARTICIPANTS: Using the Medicare Master Beneficiary Summary File and MA encounter data, this cohort study included MA enrollees with Part D coverage in 2019 and a documented diabetes diagnosis from January 1, 2017, to December 31, 2018, who filled at least 1 prescription for metformin, insulin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, or a glucagon-like peptide-1 receptor agonist (GLP-1 RA) in 2019. Analysis was conducted between December 2024 and November 2025.
MAIN OUTCOMES AND MEASURES: Unadjusted and adjusted disparities in adherence (proportion of days covered ≥80%) during 2019 were examined for insulin, metformin, and SGLT2 inhibitors and/or GLP-1 RAs, distinguishing within-plan disparities from differences between plans serving proportionately more vs fewer Black or Hispanic enrollees. Oaxaca-Blinder decomposition analysis estimated the contribution of covariates to adherence disparities.
RESULTS: Among 587 716 total beneficiaries (mean [SD] age, 72.11 [8.85] years), analyses of disparities between Black and White enrollees included 80 586 Black (63.3% female) and 233 505 White (50.9% male) beneficiaries; analyses of disparities between Hispanic and White enrollees included 83 116 Hispanic (53.9% female) and 190 509 White (51.1% male) beneficiaries. In unadjusted analyses, adherence was lower among Black beneficiaries than among White beneficiaries: -9.0 percentage points [pp] for SGLT2 inhibitors and/or GLP-1 RAs, -8.0 pp for insulin, and -10.5 pp for metformin (all P < .001). Adherence was also lower among Hispanic beneficiaries than among White beneficiaries: -8.1 pp for SGLT2 inhibitors and/or GLP-1 RAs, -2.8 pp for insulin, and -3.6 pp for metformin (all P < .001). By medication type, within-plan disparities accounted for 74.6% to 85.3% of adherence disparities between Black and White enrollees and 39.1% to 66.1% of disparities between Hispanic and White enrollees. Medicaid or Low-Income Subsidy enrollment was associated with reductions in disparities between Black and White enrollees (22.0% for insulin and 32.3% for SGLT2 inhibitors and/or GLP-1 RAs) and Hispanic and White enrollees (63.9% for insulin and 41.3% for SGLT2 inhibitors and/or GLP-1 RAs).
CONCLUSIONS AND RELEVANCE: This retrospective cohort study of MA enrollees with diabetes found racial and ethnic disparities in diabetes medication adherence. Disparities in adherence to insulin or SGLT2 inhibitors and/or GLP-1 RAs were partially mitigated by Medicaid and prescription drug subsidies but less so by plan-level factors. The findings suggest that additional insurance- and community-level strategies are needed to improve medication adherence among disadvantaged patients and communities.