Center for Drug Evaluation and Safety, Department of Pharmaceutical Evaluation and Policy, University of Florida College of Pharmacy, Gainesville, FL.
Department of Population Health Sciences, Weill Cornell Medical College, New York, NY.
Diabetes Care. 2022 Aug 1;45(8):1814-1821. doi: 10.2337/dc21-2601.
The Medicare Part D Senior Savings Model (SSM) took effect on 1 January 2021. In this study we estimated the number of beneficiaries who would benefit from SSM and the long-term health and economic consequences of implementing this new policy.
Data for Medicare beneficiaries with diabetes treated with insulin were extracted from the 2018 Medical Expenditure Panel Survey. A validated diabetes microsimulation model estimated health and economic impacts of the new policy for the 5-year initial implementation period and a 20-year extended policy horizon. Costs were estimated from a health system perspective.
Of 4.2 million eligible Medicare beneficiaries, 1.6 million (38.3%) would benefit from the policy, and out-of-pocket (OOP) costs per year per beneficiary would decrease by 61% or $500 on average. Compared with non-White subgroups, the White population subgroups would have a higher proportion of SSM enrollees (29.6% vs. 43.7%) and a higher annual OOP cost reduction (reduction of $424 vs. $531). Among the SSM enrollees, one-third (605,125) were predicted to have improved insulin adherence due to lower cost sharing and improved health outcomes. In 5 years, the SSM would 1) avert 2,014 strokes, 935 heart attacks, 315 heart failure cases, and 344 end-stage renal disease cases; 2) gain 3,220 life-years and 3,381 quality-adjusted life-years (QALY); and 3) increase insulin cost and total medical cost by $3.5 billion and $2.8 billion. In 20 years, the number of avoided clinical outcomes, number of life-years and QALY gained, and the total and insulin cost would be larger.
The Medicare SSM may reduce the OOP costs for approximately one-third of the Medicare beneficiaries treated with insulin, improving health outcomes via increased insulin adherence. However, the SSM will also increase overall Medicare spending for insulin and overall medical costs, which may impact future premiums and benefits. Our findings can inform policy makers about the potential impact of the new Medicare SSM.
医疗保险处方药老年人储蓄模式（SSM）于 2021 年 1 月 1 日生效。本研究旨在估算将从 SSM 中受益的受益人数以及实施这一新政策的长期健康和经济后果。
从 2018 年医疗支出面板调查中提取了接受胰岛素治疗的糖尿病医疗保险受益人的数据。经过验证的糖尿病微观模拟模型估计了新政策在最初 5 年实施期和 20 年扩展政策期间的健康和经济影响。从卫生系统的角度估算了成本。
在符合条件的 420 万医疗保险受益人中，有 160 万人（38.3％）将从该政策中受益，每位受益人的年自付费用将平均降低 61％或 500 美元。与非白人亚组相比，白人人口亚组的 SSM 参保人数比例更高（29.6％比 43.7％），年自付费用降低幅度更大（减少 424 美元比 531 美元）。在 SSM 参保人中，有三分之一（605,125 人）预计由于分担成本降低和健康状况改善，胰岛素的依从性会提高。在 5 年内，SSM 将避免 2,014 例中风，935 例心脏病发作，315 例心力衰竭和 344 例终末期肾病；增加 3,220 个生命年和 3,381 个质量调整生命年（QALY）；并增加胰岛素成本和总医疗费用 35 亿美元和 28 亿美元。在 20 年内，避免临床结果的数量，生命年和 QALY 的增加，以及胰岛素和总医疗费用的增加将更大。
医疗保险 SSM 可能会降低约三分之一接受胰岛素治疗的医疗保险受益人的自付费用，通过提高胰岛素的依从性来改善健康结果。但是，SSM 也会增加胰岛素和总体医疗费用的医疗保险总支出，这可能会影响未来的保费和福利。我们的研究结果可以为决策者提供有关新的医疗保险 SSM 的潜在影响的信息。
