Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
School of Public Health, Oregon Health & Science University - Portland State University, Portland, Oregon, USA.
BMJ Open Diabetes Res Care. 2021 Dec;9(Suppl 1). doi: 10.1136/bmjdrc-2021-002135.
Most patients with diabetes mellitus are prescribed medications to control their blood glucose. The implementation of the Affordable Care Act (ACA) led to improved access to healthcare for patients with diabetes. However, impact of the ACA on prescribing trends by diabetes drug category is less clear. This study aims to assess if long-acting insulin and novel agents were prescribed more frequently following the ACA in states that expanded Medicaid compared with non-expansion states.
In this analysis of a natural experiment, prescriptions reimbursed by Medicaid (US public insurance) for long-acting insulins, metformin, and novel agent medications (DPP4 inhibitors, sodium/glucose cotransporter 2 inhibitor antagonists, and glucagon-like peptide-1 receptor agonists) from 2012 to 2017 were obtained from public records. For each medication category, we performed difference-in-differences (DID) analysis modeling change in rate level from pre-ACA to post-ACA in Medicaid expansion states relative to Medicaid non-expansion states.
Expansion and non-expansion states saw a decline in both metformin and long-acting insulin prescriptions per 100 enrollees from pre-ACA to post-ACA. These decreases were larger in non-expansion states relative to expansion states (metformin: absolute DID = +0.33, 95% CI=0.323 to 0.344) and long-acting insulin (absolute DID: +0.11; 95% CI=0.098 to 0.113). Novel agent prescriptions in expansion states (+0.08 per 100 enrollees) saw a higher absolute increase per 100 Medicaid enrollees than in non-expansion states (absolute DID= +0.08, 95% CI=0.079 to 0.086).
There was a greater absolute increase for prescriptions of novel agents in expansion states relative to non-expansion states after accounting for number of enrollees. Reducing administrative barriers and improving the ability of providers to prescribe such newer therapies will be critical for caring for patients with diabetes-particularly in Medicaid non-expansion states.
大多数糖尿病患者都需要服用药物来控制血糖。《平价医疗法案》（ACA）的实施改善了糖尿病患者获得医疗保健的机会。然而，ACA 对按糖尿病药物类别开处方的趋势的影响尚不清楚。本研究旨在评估在扩大医疗补助的州与未扩大医疗补助的州相比，长效胰岛素和新型药物（二肽基肽酶-4 抑制剂、钠-葡萄糖共转运蛋白 2 抑制剂拮抗剂和胰高血糖素样肽-1 受体激动剂）在 ACA 之后是否更频繁地被开处方。
在这项自然实验的分析中，从公共记录中获取了 2012 年至 2017 年 Medicaid（美国公共保险）报销的长效胰岛素、二甲双胍和新型药物（二肽基肽酶-4 抑制剂、钠-葡萄糖共转运蛋白 2 抑制剂拮抗剂和胰高血糖素样肽-1 受体激动剂）的处方。对于每种药物类别，我们使用差异中的差异（DID）分析模型来衡量 Medicaid 扩大州和非扩大州从 ACA 前到 ACA 后每 100 名参保人用药率的变化。
在 ACA 前到 ACA 后，扩大和非扩大州的每 100 名参保人开具的二甲双胍和长效胰岛素处方都有所减少。非扩大州的降幅大于扩大州（二甲双胍：绝对 DID=+0.33，95%CI=0.323 至 0.344）和长效胰岛素（绝对 DID：+0.11；95%CI=0.098 至 0.113）。在扩大州，新型药物的处方增加了 0.08 每 100 名参保人，比非扩大州增加了 0.08 每 100 名参保人（绝对 DID=+0.08，95%CI=0.079 至 0.086）。
在考虑参保人数后，扩大州新型药物处方的绝对增幅高于非扩大州。减少行政障碍并提高提供者开此类新型疗法的能力，对于糖尿病患者的治疗至关重要，尤其是在非扩大医疗补助的州。
