Introduction
Type 2 diabetes (T2D) is a complex condition that involves inadequate insulin production and irregular blood sugar levels. Over the past two decades, the prevalence of T2D has surged from 10% to 13% in the United States alone. Pharmacotherapy plays a crucial role in managing diabetes and preventing secondary complications. These complications are becoming more prevalent in the working age population. However, the rising costs of medication present a significant barrier to optimal care. In particular for lower-income patients, leading to high out-of-pocket (OOP) payments and non-compliance.
Value-Based Medication Benefits
The average OOP for patients diagnosed with diabetes are between $150 to $500 per year for treatment. To counter the issue of escalating OOP costs, some employers have adopted more generous health insurance designs and policies to counter additional payments. One such initiative is the preventive drug list (PDL) add-on. PDLs allows patients to pay reduced co-payments or deductible amounts for high-value preventive medications, including antidiabetic drugs.
Impact of PDLs on Diabetes Management
Recent studies have found that PDLs are associated with increased preventive medication fills among diabetes patients from lower-income neighbourhoods. On the other hand, there has been a shortage of research that has investigated the correlation between value-based drug benefits and health outcomes.
A recent study from Duke University aimed to address this gap by studying whether PDLs are associated with reduced rates of acute, preventable diabetes complications. The study examined a dataset spanning a 14-year period (2004-2017) and consisting of almost 2.3 million people with diabetes who were covered by commercial insurance.
Key Findings
Patients with diabetes enrolled in a value-based medication benefit increased their antidiabetic medication use. They also experienced 8.4% fewer acute, diabetes complication days compared to controls. Notably, PDL members from lower-income areas, who experienced the largest magnitude increases in antidiabetic medication use, experienced a 10.2% decline in complication days. To the authors knowledge no other studies have been published that examined reduced medication costs in diabetes and its effects. However, in two randomised clinical trials conducted in Canada, it was discovered that the removal of drug co-payments resulted in slight to moderate increases in medication usage.
Limitations and Future Research
While the findings from this study are promising, they are not without limitations, as it only applies to patients with diabetes on commercial health plans. Further, PDL coverage was not randomly assigned, but chosen by certain employers. Finally, the study only examined outcomes associated with PDL enrollment over a single year. For more comprehensive research, larger sample sizes will be necessary to include additional clinical outcomes.
Conclusion
In conclusion, this study indicates that value-based medication benefits not only lowers antidiabetic medication OOP costs, but also shows a 8.4% reduction in preventable diabetes complications. The study results might suggest a strategy that entails incentivising the adoption of targeted cost-sharing reductions. Especially, among commercially insured patients with diabetes and lower income to enhance health outcomes.
