Background: Certain antihyperglycemic therapies modify CV disease courses in DM, but their uptake in practice appears limited among low-income adults.

Methods: We employed a difference-in-difference (DiD) design to study the association between Medicaid Expansion and non-insulin antihyperglycemic prescriptions. We used 2012-2017 National and State Medicaid data to compare prescription claims between states that did (n=25) and did not expand (n=26) Medicaid by Jan 2014.

Results: Following Medicaid Expansion, average quarterly non-insulin antihyperglycemic therapies/1000 enrollees increased by 4% in expansion and 2% in non-expansion states (left panel) with modest variation (right panel). Use of SGLT2i and GLP-1RA grew faster in early expansion than non-expansion states. DiD estimates for prescription change after Medicaid Expansion between expansion vs. non-expansion states was 1.6 (1.00 to 2.20; P<0.001) for all non-insulin therapies, 0.11 (-0.02 to 0.25; P=0.10) for SGLT2i, and 0.11 (0.04 to 0.18; P=0.002) for GLP-1RA. Excluding 7 states that expanded Medicaid after Jan 2014 yielded similar results.

Conclusion: Medicaid Expansion was associated with greater access to non-insulin antihyperglycemic therapies, including GLP-1RA, among newly insured low-income adults, even after accounting for more DM detection. Future studies are needed to understand if policies facilitating these therapeutic changes impact CV health.


A. Sumarsono: None. L. Buckley: None. S.R. Machado: None. R.K. Wadhera: None. H. Warraich: None. R.J. Desai: Research Support; Self; Bayer AG, Novartis AG. B.M. Everett: Consultant; Self; Amarin Corporation, Amgen, Merck & Co., Inc., National Institute of Diabetes and Digestive and Kidney Diseases, Roche Diagnostic USA. Consultant; Spouse/Partner; Sequana. Consultant; Self; U.S. Food and Drug Administration. Research Support; Self; National Heart, Lung, and Blood Institute. D.K. McGuire: Consultant; Self; Afimmune, Applied Therapeutics, Merck Sharp & Dohme Corp., Metavant. Other Relationship; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eisai Co., Ltd., Eli Lilly and Company, Esperion Therapeutics, Inc., GlaxoSmithKline plc., Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis. G.C. Fonarow: Consultant; Self; Abbott, AstraZeneca, Janssen Pharmaceuticals, Inc., Medtronic, Novartis Pharmaceuticals Corporation. J. Butler: Consultant; Self; Amgen, Array BioPharma, AstraZeneca, Bayer AG, Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb, CVRx, G3 Pharmaceuticals, Innolife Co., Ltd., Janssen Pharmaceuticals, Inc., Luitpold Pharmaceuticals, Inc., Medtronic, Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Relypsa, Inc., VIfor. A. Pandey: None. M. Vaduganathan: Advisory Panel; Self; Bayer AG, Boehringer Ingelheim Pharmaceuticals, Inc., Relypsa, Inc. Consultant; Self; Amgen, AstraZeneca, Baxter.

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