Background: Understanding the total cost of care (TCoC) specific to type-2 diabetes (T2D) is challenging. Diabetes is a driver of multiple chronic medical conditions, each with a constellation of costs. As such, medication trends specific to T2D may help inform assessment of population health and care management.

Methods: For a population of 7,361 commercially insured persons (≥18 years old) enrolled in a virtual care accountable care organization (Level2) , we examined de-identified administrative claims in a research database for T2D medications from 12/1/2019-11/30/2021. We determined the TCoC for this population, as well as changes in spending and utilization by medication class.

Results: Among individuals enrolled in Level2, spending for T2D medications constituted 31.2% of the total spend over the period studied. Spending and utilization changes are summarized in Table 1.

Conclusion: T2D care is rapidly evolving; ongoing changes in cost and utilization are dramatic. For organizations in risk arrangements, following and projecting medication spend in T2D is a critical exercise, as is driving the guideline-directed use of these agents. There is a need for greater specificity in T2D medication guidelines that considers cost-effectiveness and tailors treatment choice to the specific patient risk.


D.J.Cook: None. A.Defail: Employee; Level2. N.Thompson: Employee; Level2. D.Pederson: Employee; Level2.

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