Visual Abstract

Introduction: High patient out-of-pocket (OOP) cost for insulin led to a program limiting OOP to $35/30-day supply in select Medicare Part D plans. This study assessed the association between insulin utilization and insulin OOP cost in Medicare Advantage (MA) patients with diabetes.

Methods: This study included MA patients with type 1 (T1D) or 2 diabetes (T2D) in the OptumLabs® Data Warehouse, a longitudinal, real-world data asset with de-identified administrative claims and electronic health record data, from 2006-2018. Index date was January 1 following two insulin claims the prior year. Patients were grouped by average insulin OOP cost/30-day supply during the 1-year follow-up period: $0, >$0-$20, >$20-$35, >$35-$50, and >$50. The proportion of patients with a 90 continuous-day gap in insulin therapy, mean number of insulin claims, and insulin daily average consumption (DACON) were compared by OOP group using descriptive statistics.

Results: The study included 7,210 T1D and 174,439 T2D patients (Table). Versus >$0-$20, patients in >$20 OOP groups filled fewer insulin claims and had lower mean DACON; more T2D patients in >$35 OOP groups experienced a gap in therapy. Similar trends were seen in T1D patients in >$35 OOP groups.

Conclusions: Expanding the insulin $35 OOP cost limit in MA may help avoid gaps in insulin therapy and preserve daily insulin use in MA patients with diabetes.

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Disclosure

N. Ruiz-negron: Research Support; Self; Genentech, Inc., Novartis Pharmaceuticals Corporation. J. Sullivan: None. J. Tucker: None. C. Mcadam-marx: None.

Funding

Robert Wood Johnson Foundation; Health Data for Action Research Program (ID77105)

© 2021 by the American Diabetes Association
2021
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