州胰岛素自付上限与商业保险糖尿病患者胰岛素费用分担和使用的关联：一项有对照组的前后研究。

Association of State Insulin Out-of-Pocket Caps With Insulin Cost-Sharing and Use Among Commercially Insured Patients With Diabetes : A Pre-Post Study With a Control Group.

机构信息

Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (L.F.G., F.Z., R.C., S.A., D.R.).

Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, and Department of Medicine and Duke-Margolis Institute for Health Policy, Duke University, Durham, North Carolina (J.F.W.).

出版信息

Ann Intern Med. 2024 Apr;177(4):439-448. doi: 10.7326/M23-1965. Epub 2024 Mar 26.

DOI:10.7326/M23-1965

PMID:38527286

Abstract

BACKGROUND

Twenty-five states have implemented insulin out-of-pocket (OOP) cost caps, but their effectiveness is uncertain.

OBJECTIVE

To examine the effect of state insulin OOP caps on insulin use and OOP costs among commercially insured persons with diabetes.

DESIGN

Pre-post study with control group.

SETTING

Eight states implementing insulin OOP caps of $25 to $30, $50, or $100 in January 2021, and 17 control states.

PARTICIPANTS

Commercially insured persons with diabetes and insulin users younger than 65 years. Subgroups of particular interest included members from states with insulin OOP caps of $25 to $30, enrollees with health savings accounts (HSAs) that require high insulin OOP payments, and lower-income members.

MEASUREMENTS

Mean monthly 30-day insulin fills and OOP costs.

RESULTS

State insulin caps were not associated with changes in insulin use in the overall population (relative change in fills per month, 1.8% [95% CI, -3.2% to 6.9%]). Insulin users in intervention states saw a 17.4% (CI, -23.9% to -10.9%) relative reduction in insulin OOP costs, largely driven by reductions among HSA enrollees; there was no difference in OOP costs among nonaccount plan members. More generous ($25 to $30) state insulin OOP caps were associated with insulin OOP cost reductions of 40.0% (CI, -62.5% to -17.6%), again primarily driven by a larger reduction in the subgroup with HSA plans.

LIMITATIONS

Single national insurer; 9-month follow-up.

CONCLUSION

Insulin OOP caps were associated with reduced insulin OOP costs but no overall increases in insulin use. A proposed national insulin cap of $35 for commercially insured persons might lead to meaningful insulin OOP savings but have a limited effect on insulin use.

PRIMARY FUNDING SOURCE

Centers for Disease Control and Prevention and National Institute of Diabetes and Digestive and Kidney Diseases.

摘要

背景

已有 25 个州实施了胰岛素自付费用（OOP）上限，但效果尚不确定。

目的

研究各州胰岛素 OOP 上限对商业保险糖尿病患者胰岛素使用和 OOP 费用的影响。

设计

前后对照研究，有对照组。

地点

2021 年 1 月，8 个州实施了 25 至 30 美元、50 美元或 100 美元的胰岛素 OOP 上限，17 个对照组州。

参与者

商业保险的糖尿病患者和年龄小于 65 岁的胰岛素使用者。特别关注的亚组包括来自胰岛素 OOP 上限为 25 至 30 美元的州的成员、需要高胰岛素 OOP 支付的健康储蓄账户（HSA）参保人，以及低收入成员。

测量

每月 30 天胰岛素剂量和 OOP 费用。

结果

州胰岛素上限与总体人群胰岛素使用变化无关（每月剂量的相对变化，1.8%[-3.2%至 6.9%]）。干预州的胰岛素使用者胰岛素 OOP 费用相对减少了 17.4%（CI，-23.9%至-10.9%），主要是 HSA 参保人的减少所致；非账户计划成员的 OOP 费用没有差异。更慷慨的（25 至 30 美元）州胰岛素 OOP 上限与胰岛素 OOP 成本降低 40.0%（CI，-62.5%至-17.6%）相关，这主要是由于 HSA 计划亚组的降幅更大。