1180-OR: Health Effects of Two Strategies to Enhance Health Care Affordability: Medication-Targeted vs. Broad Out-of-Pocket Cost Reductions

by sugaradmin



Introduction and Objective: Health care has become unaffordable for many diabetes patients. We examined 3-year health effects of: (1) Preventive Drug List (PDL) benefits that set drug cost sharing to $0, including for insulin, GLP-1 RA, & SGLT2i; (2) switches from high-deductible (HDHP; ≥$1000) to low-deductible health plans (LDHP; ≤$500) that broadly reduce cost sharing for outpatient, emergency, & inpatient services.Methods: We used 2007-21 data from a large national health plan to assess diabetes patients aged 12-64, using a matched controlled interrupted time series design. Intervention members had a 1-year baseline, then experienced employer-mandated benefit changes (to PDL or HDHP-to-LDHP), then were followed in for 3 years. The primary outcome was acute diabetes complications. Secondary outcomes included primary care & specialist visits, and insulin & non-insulin antidiabetic use (including GLP-1 RAs & SGLT2i). PDL analyses included 6516 intervention members & 157897 matched controls. HDHP-to-LDHP analyses included 1097 intervention members & 61575 matched controls.Results: After PDL switches, medication use increased vs controls, including insulin (6.7%; 95% CI: 6.3-7.1), non-insulin antidiabetic drugs (6.2%; 6.0-6.4), GLP-1 RAs (15.8%; 14.8-16.7), & SGLT2is (10.3%; 9.3-11.3). Acute complications declined by 11.5% (−17.2,−5.7). Members experiencing HDHP-to-LDHP switches had increased primary care visits (6.9%; 3.1-10.6), specialist visits (5.1%; 1.3-8.9), insulin use (2.8%; 1.9-3.7), and non-insulin antidiabetic use (2.0%; 1.5-2.4). Acute complications declined by 24.5% (−36.2,−12.7).Conclusion: Over 3 years, both medication-targeted & broad cost-sharing reductions were associated with improved diabetes outcomes, but via distinct utilization paths. PDLs primarily increased use of effective pharmacotherapy & moderately reduced diabetes complications, whereas HDHP-to-LDHP switches increased outpatient care & were associated with large reductions in acute complications.

Disclosure

J.F. Wharam: None. R. Costa: None. S. Argetsinger: None. F. Zhang: Research Support; Current; Pfizer Inc., GlaxoSmithKline plc. D. Ross-Degnan: None.

Funding

CDC and NIDDK (1U18DP006122, 1U18DP006527)



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