Centers for High Value Health Care and Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, PA.
Evernorth, St. Louis, MO.
Med Care. 2021 Sep 1;59(9):789-794. doi: 10.1097/MLR.0000000000001597.
The objective of this study was to describe national changes in utilization and associated costs of antidiabetic medications in the United States from 2014 to 2019, across different drug classes and insurance plans.
This retrospective, cross-sectional study examined administrative claims from a large national pharmacy benefits manager from January 1, 2014, to December 31, 2019. Patients aged 18 years and above enrolled in commercial, Medicare, or Medicaid health plans who filled ≥1 prescription claim for an antidiabetic medication(s) during the 6-year period were included. Utilization was examined as the total number of 30-day adjusted prescription fills per user per month (PUPM). Gross costs were calculated as the sum of plan costs (net of rebates) and member out-of-pocket costs. Differences in mean utilization and costs PUPM between 2014 and 2019 for each medication class were calculated.
The final analytic sample increased from 745,290 patients in 2014 to 1,596,006 in 2019. Antidiabetic medication utilization increased by 8.8% from 2014 to 2019, driven by increases in sodium-glucose cotransporter 2 inhibitor (48.7%; P<0.001), glucagon-like peptide 1 receptor agonist (11.8%; P<0.001), insulin (8.1%; P<0.001), and metformin (2.9%; P<0.05) utilization. Average costs PUPM rose 47.5% (P<0.001), from $126.52 in 2014 to $186.58 in 2019. Sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and combination drugs contributed significantly to these increased costs, with 6-year cost differences of 57.3%, 46.9%, and 47.2%, respectively (all P<0.001).
Our study demonstrates a shift in antidiabetic medication class utilization from 2014 to 2019, where associated costs net of rebates significantly increased to a disproportionately greater extent than the significant increase in utilization PUPM.
本研究旨在描述 2014 年至 2019 年期间，美国不同药物类别和保险计划中抗糖尿病药物的使用情况和相关费用的变化。
本回顾性、横断面研究分析了一家大型全国药房福利管理公司 2014 年 1 月 1 日至 2019 年 12 月 31 日的行政索赔数据。年龄在 18 岁及以上的患者，参加商业、医疗保险或医疗补助健康计划，在 6 年内至少有一次抗糖尿病药物（s）处方。使用情况以每个用户每月的 30 天调整后的处方填充次数（PUPM）来评估。总费用的计算方法为计划费用（回扣后）和会员自付费用之和。计算了每个药物类别在 2014 年至 2019 年之间 PUPM 平均使用率和成本的差异。
最终分析样本从 2014 年的 745,290 名患者增加到 2019 年的 1,596,006 名患者。抗糖尿病药物的使用率从 2014 年到 2019 年增加了 8.8%，这主要是由于钠-葡萄糖共转运蛋白 2 抑制剂（48.7%；P<0.001）、胰高血糖素样肽 1 受体激动剂（11.8%；P<0.001）、胰岛素（8.1%；P<0.001）和二甲双胍（2.9%；P<0.05）使用率的增加。平均每个用户每月的成本 PUPM 上升了 47.5%（P<0.001），从 2014 年的 126.52 美元上升到 2019 年的 186.58 美元。钠-葡萄糖共转运蛋白 2 抑制剂、胰高血糖素样肽 1 受体激动剂和联合药物对这些增加的费用做出了重大贡献，6 年的成本差异分别为 57.3%、46.9%和 47.2%（均 P<0.001）。
我们的研究表明，抗糖尿病药物类别的使用情况从 2014 年到 2019 年发生了变化，在扣除回扣后，相关费用显著增加，而 PUPM 的使用率显著增加，这一比例不成比例地更大。
