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Medicaid Expansion and Utilization of Antihyperglycemic Therapies.
- Source :
- Diabetes Care; Nov2020, Vol. 43 Issue 11, p2684-2690, 7p
- Publication Year :
- 2020
-
Abstract
- <bold>Objective: </bold>Certain antihyperglycemic therapies modify cardiovascular and kidney outcomes among patients with type 2 diabetes, but early uptake in practice appears restricted to particular demographics. We examine the association of Medicaid expansion with use of and expenditures related to antihyperglycemic therapies among Medicaid beneficiaries.<bold>Research Design and Methods: </bold>We employed a difference-in-difference design to analyze the association of Medicaid expansion on prescription of noninsulin antihyperglycemic therapies. We used 2012-2017 national and state Medicaid data to compare prescription claims and costs between states that did (n = 25) and did not expand (n = 26) Medicaid by January 2014.<bold>Results: </bold>Following Medicaid expansion in 2014, average noninsulin antihyperglycemic therapies per state/1,000 enrollees increased by 4.2%/quarter in expansion states and 1.6%/quarter in nonexpansion states. For sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA), quarterly growth rates per 1,000 enrollees were 125.3% and 20.7% for expansion states and 87.6% and 16.0% for nonexpansion states, respectively. Expansion states had faster utilization of SGLT2i and GLP-1RA than nonexpansion states. Difference-in-difference estimates for change in volume of prescriptions after Medicaid expansion between expansion versus nonexpansion states was 1.68 (95% CI 1.09-2.26; P < 0.001) for all noninsulin therapies, 0.125 (-0.003 to 0.25; P = 0.056) for SGLT2i, and 0.12 (0.055-0.18; P < 0.001) for GLP-1RA.<bold>Conclusions: </bold>Use of noninsulin antihyperglycemic therapies, including SGLT2i and GLP-1RA, increased among low-income adults in both Medicaid expansion and nonexpansion states, with a significantly greater increase in overall use and in GLP-1RA use in expansion states. Future evaluation of the population-level health impact of expanded access to these therapies is needed. [ABSTRACT FROM AUTHOR]
- Subjects :
- SODIUM-glucose cotransporter 2 inhibitors
GLUCAGON-like peptide 1
MEDICAID
PEPTIDE receptors
TYPE 2 diabetes
ECONOMIC impact
RESEARCH
RESEARCH methodology
MEDICAL cooperation
EVALUATION research
COMPARATIVE studies
RESEARCH funding
DRUG utilization
PATIENT Protection & Affordable Care Act
POVERTY
Subjects
Details
- Language :
- English
- ISSN :
- 01495992
- Volume :
- 43
- Issue :
- 11
- Database :
- Complementary Index
- Journal :
- Diabetes Care
- Publication Type :
- Academic Journal
- Accession number :
- 146526391
- Full Text :
- https://doi.org/10.2337/dc20-0735