*Purpose: Medication adherence is critical to positive outcomes in renal transplant recipients (RTRs), and policies have been designed encouraging adherence. For example, Medicare Part D Star Ratings of quality of health and drug services received by individuals enrolled in Medicare Advantage (MAPD) and Prescription Drug plans promote positive outcomes and are associated with incentives including federal bonus payments made to MAPDs and possible increases in plan enrollment. Medication adherence measures for diabetes (DM), hypertension (HTN; renin-angiotensin system antagonists), and cholesterol (statins) are the only 3 medication utilization measures considered for plan ratings in the Part D Star Ratings system in 2018. Methods to calculate Star Ratings may contribute to racial/ethnic disparities, causing MAPDs to focus on certain patients meeting Star Ratings inclusion criteria, and possibly disincentivizing needed services/programs to those who do not meet criteria. The study objective is to determine if measurement of Star Ratings adherence metrics among RTRs with DM, HTN, and dyslipidemia (DLD) lead to racial/ethnic disparities.

*Methods: This was a cross-sectional analysis of 305,077 adult RTRs with Medicare claims between 2010 and 2016, and receiving continuous coverage of Medicare Parts A/B/D and alive in 2017. Utilizing 2017 Medicare claims linked to Area Health Resources Files, inclusion in measure calculation was determined based on inclusion/exclusion criteria in metrics for adherence to DM, HTN, and cholesterol medications in Star Ratings. Logistic regression and multinomial logistic regression were used to calculate odds ratios (ORs), relative risk ratios (RRRs) and adjust for patient/community characteristics.

*Results: Compared to non-Hispanic White RTRs, minorities were less likely to meet criteria to be included in calculations for Star Ratings adherence measures. Among RTRs with DM, adjusted ORs for inclusion of Black, Hispanic, and Asian/Pacific Islander RTRs were 0.56 (95% Confidence Interval [CI] 0.53 – 0.60), 0.53 (95% CI 0.50 – 0.57), and 0.69 (95% CI 0.63 – 0.76), respectively. Findings were similar among RTRs with HTN and DLD. Among individuals with 2 or 3 chronic conditions, minorities were likely to be included in the calculation of fewer measures than their White counterparts. For example, among individuals with all 3 conditions, adjusted RRRs for Black compared to White RTRs for being included in calculation of 3, 2, or 1 measure were 0.31 (95% CI 0.27 – 0.36), 0.41 (95% CI 0.36 – 0.46), and 0.46 (95% CI 0.37 – 0.56), respectively.

*Conclusions: Disparities exist among RTRs with DM, HTN, and/or DLD qualifying for inclusion in Star Ratings measures. Racial/ethnic minorities are less likely to be included compared to White patients, potentially creating health disparities and adverse outcomes.

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