TY - JOUR
T1 - The effects of patient out-of-pocket costs on insulin use among people with type 1 and type 2 diabetes with Medicare Advantage insurance—2014–2018
AU - McAdam-Marx, Carrie
AU - Ruiz-Negron, Natalia
AU - Sullivan, Jane M.
AU - Tucker, Jamie M.
N1 - Publisher Copyright:
© 2023 The Authors. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.
PY - 2024/2
Y1 - 2024/2
N2 - Objective: To identify the association between insulin out-of-pocket costs (OOPC) and adherence to insulin in Medicare Advantage (MA) patients. Data Sources and Study Setting: The study is based on Optum Labs Data Warehouse, a longitudinal, real-world data asset with de-identified administrative claims and electronic health record data. Study Design: Using descriptive and multivariable logistic regression analyses, we identified the likelihood of patients with diabetes having ≥60 consecutive days between an expected insulin fill date and the actual fill date (refill lapse) by OOPC, categorized by $0, >$0–$20 (reference), >$20–$35, >$35–$50, and > $50 per 30-day supply. Data Collection/Extraction Methods: The study included MA enrollees with type 1 or type 2 diabetes and prescription claims for insulin between 2014 and 2018. Principal Findings: Those with average insulin OOPC per 30-day supply >$35 or $0 were more likely to have an insulin refill lapse versus OOPC of >$0 to $20, with odds ratios ranging 1.18 (95% CI 1.13–1.22) to 1.74 (95% CI 1.66–1.83) depending on OOPC group and diabetes type. Conclusions: Capping average insulin OOPC at $35 per 30-day supply may help avoid cost-related insulin non-adherence in MA patients; efforts to address non-cost barriers to medication adherence remain important.
AB - Objective: To identify the association between insulin out-of-pocket costs (OOPC) and adherence to insulin in Medicare Advantage (MA) patients. Data Sources and Study Setting: The study is based on Optum Labs Data Warehouse, a longitudinal, real-world data asset with de-identified administrative claims and electronic health record data. Study Design: Using descriptive and multivariable logistic regression analyses, we identified the likelihood of patients with diabetes having ≥60 consecutive days between an expected insulin fill date and the actual fill date (refill lapse) by OOPC, categorized by $0, >$0–$20 (reference), >$20–$35, >$35–$50, and > $50 per 30-day supply. Data Collection/Extraction Methods: The study included MA enrollees with type 1 or type 2 diabetes and prescription claims for insulin between 2014 and 2018. Principal Findings: Those with average insulin OOPC per 30-day supply >$35 or $0 were more likely to have an insulin refill lapse versus OOPC of >$0 to $20, with odds ratios ranging 1.18 (95% CI 1.13–1.22) to 1.74 (95% CI 1.66–1.83) depending on OOPC group and diabetes type. Conclusions: Capping average insulin OOPC at $35 per 30-day supply may help avoid cost-related insulin non-adherence in MA patients; efforts to address non-cost barriers to medication adherence remain important.
KW - Medicare Advantage
KW - cost-share
KW - diabetes
KW - insulin
KW - medication adherence
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U2 - 10.1111/1475-6773.14152
DO - 10.1111/1475-6773.14152
M3 - Article
C2 - 36992575
AN - SCOPUS:85151920304
SN - 0017-9124
VL - 59
JO - Health Services Research
JF - Health Services Research
IS - 1
M1 - e14152
ER -