1. The effects of patient out-of-pocket costs on insulin use among people with type 1 and type 2 diabetes with Medicare Advantage insurance -- 2014-2018
- Author
-
McAdam-Marx, Carrie, Ruiz-Negron, Natalia, Sullivan, Jane M., and Tucker, Jamie M.
- Subjects
Out-of-pocket expenses -- Influence ,Medicare -- Usage ,Patient compliance -- Analysis ,Insulin -- Usage -- Economic aspects ,Diabetics -- Economic aspects ,Business ,Health care industry - Abstract
Objective: To identify the association between insulin out-of-pocket costs (OOPC) and adherence to insulin in Medicare Advantage (MA) patients. Data Sources and Study Setting: The study is based on Optum Labs Data Warehouse, a longitudinal, real-world data asset with de-identified administrative claims and electronic health record data. Study Design: Using descriptive and multivariable logistic regression analyses, we identified the likelihood of patients with diabetes having [greater than or equal to]60 consecutive days between an expected insulin fill date and the actual fill date (refill lapse) by OOPC, categorized by $0, >$0-$20 (reference), >$20-$35, >$35-$50, and > $50 per 30-day supply. Data Collection/Extraction Methods: The study included MA enrollees with type 1 or type 2 diabetes and prescription claims for insulin between 2014 and 2018. Principal Findings: Those with average insulin OOPC per 30-day supply >$35 or $0 were more likely to have an insulin refill lapse versus OOPC of >$0 to $20, with odds ratios ranging 1.18 (95% CI 1.13-1.22) to 1.74 (95% CI 1.66-1.83) depending on OOPC group and diabetes type. Conclusions: Capping average insulin OOPC at $35 per 30-day supply may help avoid cost-related insulin non-adherence in MA patients; efforts to address non-cost barriers to medication adherence remain important. KEYWORDS cost-share, diabetes, insulin, Medicare Advantage, medication adherence What is known on this topic * Insulin prices have increased dramatically over the past 15 years as have patient out-of-pocket costs (OOPC) for insulin. * OOPC is a known barrier to diabetes medication adherence, including insulin. * The Medicare Part D Innovations Senior Savings Model is a pilot program that limits insulin prescription OOPC to $35 per month for select insulins through participating enhanced Part D plans. What this study adds * Over 30% of Medicare Advantage enrollees taking insulin had a lapse of 60 or more consecutive days between the time an insulin prescription was due for a refill and the actual refill date. * Those with average insulin OOPC per 30-day supply of more than $35 were more likely to have an insulin refill lapse than those who paid out-of-pocket for insulin but at an amount of $20 or less. * Capping insulin OOPC to no more than $35 per 30-day supply may help to avoid cost-related non-adherence, but efforts to address other barriers to adherence continue to be important., 1 | INTRODUCTION In response to rising insulin prices and patient cost share, (1,2) states and payers have implemented policies limiting patients' share of insulin cost. By the end of [...]
- Published
- 2024
- Full Text
- View/download PDF