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Value-based medication plans that reduce out-of-pocket costs for diabetes medications reduce health complications for privately insured people with diabetes, especially those living in low-income areas.
- The researchers assessed the effects over a one-year period. Type 2 diabetes Preventive Drug List (PDL) results, which employers can add to plans to reduce out-of-pocket costs (co-pays or deductibles) for high-cost preventive medications.
- Using data from a national insurer, the researchers identified 10,588 people with diabetes who were newly enrolled in PDL plans between January 2004 and June 2017 (ages 12-64; 44.8% female; 45.5% from the South; 33.4% from employers with fewer than 100 members).
- Diabetic patients who had PDL plans throughout the follow-up period were weighted and compared with 690,075 control participants whose employers did not offer PDL.
- Subgroup analyses assessed the health status of diabetic patients living in low-income areas (53.1%).
- The primary endpoints were bacterial infections, neurovascular events, acute coronary events, and Diabetic ketoacidosisIt is measured as the number of complication days per 1,000 members per year.
- Out-of-pocket expenses for non-insulin antidiabetic drugs and Insulin The PDL group had a decrease of 30.7% and 38.6%, respectively, compared with the control group.
- Among PDL members, prescription fillings of 30-day supplies of non-insulin and insulin-based diabetes medications increased by 7.1% (95% CI, 5.0% to 9.3%) and 5.3% (95% CI, 2.2% to 8.4%), respectively, and were slightly higher among PDL members living in low-income areas.
- Conversion to PDL was associated with an 8.4% relative reduction (95% CI, -13.9% to -2.8%) in overall complication days (absolute reduction, -20.2 days per 1000 patients per year).
- Among members of low-income communities, transition to PDL was associated with a 10.2% relative reduction (95% CI, -17.4% to -3.0%) in complication days (absolute reduction, -26.1 per 1000 people per year) compared with the control group.
“Targeting out-of-pocket cost reductions among specific populations, in this case people with diabetes in low-income areas, may improve health outcomes,” the authors wrote.
The study was conducted by J. Franklin Wharham, MD, MPH, of the Duke University School of Medicine in Durham, North Carolina. online in JAMA Health Forum.
The findings of this study may only be generalizable to people with diabetes who have private health insurance. PDL coverage was selected by specific employers rather than randomized. Furthermore, only outcomes associated with new PDL enrollment over a 1-year period were evaluated.
This study was funded by grants from the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases. One author reported receiving post-marketing safety study grants from Pfizer and GlaxoSmithKline outside the submitted work.