1176-OR: State-Level Variation in Medicaid Diabetes Drug Access, Use, and Adherence in the United States, 2016–2023

by sugaradmin



Introduction and Objective: State Medicaid programs differ widely in formulary design and prescribing practices for diabetes medications. Little is known about how formulary breadth translates into treatment initiation and sustained adherence. We assessed state-level variation in access, utilization, and adherence to major diabetes drug classes and examined alignment between formulary breadth and medication use.Methods: Using 2016-2023 Transformed Medicaid Statistical Information System pharmacy claims, we identified adults with type 2 diabetes. Medications were classified into six non-insulin classes and insulin using RxNorm standardized clinical drugs. Formulary breadth was measured as the number of distinct single-chemical drugs dispensed per state. Extensive margin utilization captured any use of a class; intensive margin utilization included adherence measured by proportion of days covered (PDC ≥0.80), calculated within enrollment periods.Results: Across all classes, states dispensed only half to two-thirds of nationally approved formulations. Substantial heterogeneity was observed in both treatment initiation and adherence. Some states demonstrated strong alignment—broad formularies, high use, and high adherence—while others exhibited misalignment, including broad access with low adherence or narrow access with selective but durable use. Misalignment was most pronounced for GLP-1 receptor agonists, SGLT2 inhibitors, and insulin. Across states, mean PDC clusters around 60-65%. The share of beneficiaries with high adherence (PDC ≥ 80%) varies substantially, ranging from about 13% to 64%, with highest adherence in states such as RI, VT, NE, and lowest in MS, UT, SC.Conclusion: Medicaid diabetes care shows marked state-level variation in access, use, and adherence. Formulary breadth alone does not ensure sustained medication use, highlighting the need for policies that address both initiation and continuity of therapy.

Disclosure

M.L. Alva: None. B. Ng: None. A. Crowell: None. M. Magee: None.

Funding

National Institutes of Health (5R01MD017071-04)



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