Effects of Adopting Preventive Drug Lists on Medication Costs and Disparities by Income Over 2 Years: A Natural Experiment for Translation in Diabetes (NEXT-D) Study

IF 14.8 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Diabetes Care Pub Date : 2024-10-08 DOI:10.2337/dc24-0361
Christine Y. Lu, Stephanie Argetsinger, Matthew Lakoma, Fang Zhang, J. Frank Wharam, Dennis Ross-Degnan
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Abstract

OBJECTIVE To examine the association between preventive drug lists (PDLs) and changes in medication costs among patients with diabetes insured in commercial health plans over 2 follow-up years. RESEARCH DESIGN AND METHODS We conducted a quasiexperimental study using the Optum deidentified Clinformatics Data Mart Database (January 2003 to December 2017). The intervention group included 5,582 patients with diabetes age 12–64 years switched by employers to PDL coverage; the control group included 5,582 matched patients whose employers offered no PDL. Outcomes included out-of-pocket costs, standardized costs, and 30-day fills for all medications because PDL-associated savings could be used to pay for medicines in other classes and for five therapeutic classes covered by the PDLs (oral diabetic medications, insulins, test strips, antihypertensive drugs, and lipid-lowering drugs). RESULTS Pre– to post–out-of-pocket spending for all medications declined by 29.7% in follow-up year 2 (95% CI −36.0, −23.4%) among PDL members relative to controls. Higher-income and lower-income PDL members experienced significant reductions in out-of-pocket spending for all medications in year 2 (30%) and for key therapeutic classes (range −23 to −67%). We found significant increases in use of key therapeutic classes in the overall population (range 8–15%) and in higher-income and lower-income PDL members (range 9–50%). CONCLUSIONS PDLs offer an effective strategy for employers and insurers to lower member cost sharing and encourage increased use of important medications to prevent or manage chronic illnesses. For patients with diabetes, especially those with lower incomes, PDL coverage resulted in substantial and persistent reductions in out-of-pocket medication costs, medication use increases, and some increased use of more expensive products.
采用预防性药物清单对两年内用药成本和收入差距的影响:糖尿病转化自然实验 (NEXT-D) 研究
目的 研究商业健康计划投保的糖尿病患者在两个随访年度内的预防性用药清单(PDLs)与用药成本变化之间的关联。研究设计与方法 我们使用 Optum 去标识化 Clinformatics Data Mart 数据库(2003 年 1 月至 2017 年 12 月)进行了一项准实验研究。干预组包括 5,582 名 12-64 岁的糖尿病患者,他们的雇主将其转为 PDL 承保;对照组包括 5,582 名匹配的患者,他们的雇主未提供 PDL。结果包括所有药物的自付费用、标准化费用和 30 天用药量,因为与 PDL 相关的节余可用于支付其他类别的药物以及 PDL 涵盖的五种治疗类别(口服糖尿病药物、胰岛素、试纸、降压药和降脂药)的费用。结果 在随访的第 2 年,PDL 会员与对照组相比,所有药物的自费前和自费后支出下降了 29.7%(95% CI -36.0, -23.4%)。收入较高和收入较低的 PDL 会员在第 2 年的所有药物和主要治疗类别的自付支出均显著减少(30%)(范围为 -23% 至 -67%)。我们发现,在总体人群中(范围为 8%-15%)以及在高收入和低收入 PDL 会员中(范围为 9%-50%),关键治疗类药物的使用率明显增加。结论 PDL 为雇主和保险公司提供了一种有效的策略,可以降低会员的费用分担,并鼓励增加重要药物的使用,以预防或控制慢性疾病。对于糖尿病患者,尤其是低收入患者来说,PDL 的覆盖使他们的自付药费大幅持续降低,用药量增加,并且在一定程度上增加了对更昂贵产品的使用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Diabetes Care
Diabetes Care 医学-内分泌学与代谢
CiteScore
27.80
自引率
4.90%
发文量
449
审稿时长
1 months
期刊介绍: The journal's overarching mission can be captured by the simple word "Care," reflecting its commitment to enhancing patient well-being. Diabetes Care aims to support better patient care by addressing the comprehensive needs of healthcare professionals dedicated to managing diabetes. Diabetes Care serves as a valuable resource for healthcare practitioners, aiming to advance knowledge, foster research, and improve diabetes management. The journal publishes original research across various categories, including Clinical Care, Education, Nutrition, Psychosocial Research, Epidemiology, Health Services Research, Emerging Treatments and Technologies, Pathophysiology, Complications, and Cardiovascular and Metabolic Risk. Additionally, Diabetes Care features ADA statements, consensus reports, review articles, letters to the editor, and health/medical news, appealing to a diverse audience of physicians, researchers, psychologists, educators, and other healthcare professionals.
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