The Comparative Health Outcomes, Policy, and Economics Institute, School of Pharmacy, University of Washington, Seattle.
JAMA Netw Open. 2024 Jul 1;7(7):e2420724. doi: 10.1001/jamanetworkopen.2024.20724.
For people with type 2 diabetes (T2D), out-of-pocket medication costs may influence medication choice, adherence, and overall diabetes management and progression. Little is known about how these costs change as insured people enter Medicare at age 65 years, when coinsurance in the coverage gap and catastrophic phases of Part D coverage can be increased greatly by use of insulin and newer, branded medications (eg, dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 agonists, and sodium-glucose cotransporter 2 inhibitors).
To identify whether reaching age 65 years is associated with T2D medication out-of-pocket costs and utilization.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study (2012-2020) featuring 7 years of follow-up used prescription drug claims data from the TriNetX Diamond Network. Participants included people in the US with diagnosed T2D, and claims for T2D medications were observed both before and after age 65 years. Data analysis was performed from October 2022 to September 2023.
Reaching age 65 years, according to participants' year of birth.
The primary outcome was patient out-of-pocket costs for T2D drugs per quarter (inflation adjusted to 2020 dollars). Utilization, measured as binary utilization of specific classes, and the number of claims for mutually exclusive classes and combinations of classes were also examined. All outcomes were examined using regression discontinuity design.
In claims data for 129 997 individuals with T2D diagnosed at ages 58 to 72 years (mean [SD] age, 65.50 [2.95] years; 801 235 female [50.9%]), reaching age 65 years was associated with an increase of $23.04 (95% CI, $19.86-$26.22) in mean quarterly out-of-pocket costs for T2D drugs, and an increase of $56.36 (95% CI, $51.48-$61.23) at the 95th percentile of spending, after utilization adjustment. Utilization decreased by 5.3% at age 65 years, from 3.40 claims per quarter (95% CI, 3.38-3.42 claims per quarter) to 3.22 claims per quarter (95% CI, 3.21-3.24 claims per quarter), but a shift in composition of utilization, including increased insulin use, was associated with additional increases in patient costs.
In this cohort study of individuals with T2D, the increase in spending upon reaching age 65 years (when most people enroll in Medicare) was associated with patient coinsurance in the coverage gap and catastrophic coverage phases of Medicare Part D. The increased patient cost burden at age 65 years and a modest reduction in overall T2D drug utilization suggest that as people with T2D age into Medicare, there is potentially an increase in nonadherence and diabetes complications.
对于 2 型糖尿病（T2D）患者，自付药物费用可能会影响药物选择、依从性以及整体糖尿病管理和进展。对于参保人在 65 岁时进入医疗保险时这些费用如何变化，人们知之甚少，因为在医疗保险部分 D 保险覆盖缺口和灾难性阶段，使用胰岛素和更新、品牌药物（例如二肽基肽酶 4 抑制剂、胰高血糖素样肽 1 激动剂和钠-葡萄糖共转运蛋白 2 抑制剂）会大大增加共同保险和灾难性费用。
确定达到 65 岁是否与 T2D 药物自付费用和使用情况有关。
设计、地点和参与者：这项回顾性队列研究（2012-2020 年），随访 7 年，使用了来自 TriNetX Diamond 网络的处方药索赔数据。参与者包括美国患有 T2D 的人群，在 65 岁之前和之后都观察了 T2D 药物的索赔情况。数据分析于 2022 年 10 月至 2023 年 9 月进行。
根据参与者的出生年份达到 65 岁。
主要结果是每季度 T2D 药物患者自付费用（按 2020 年美元通胀调整）。还检查了特定类别药物的使用情况（二进制使用），以及互斥类别和类别组合的索赔数量。所有结果均使用回归间断设计进行检查。
在 129997 名 58 至 72 岁诊断为 T2D 的个体的索赔数据中（平均[SD]年龄，65.50[2.95]岁；801235 名女性[50.9%]），达到 65 岁与 T2D 药物每季度自付费用平均增加 23.04 美元（95%CI，19.86-26.22 美元）有关，并且在利用调整后，支出的第 95 百分位数增加了 56.36 美元（95%CI，51.48-61.23 美元）。在 65 岁时，利用率从每季度 3.40 次索赔（95%CI，每季度 3.38-3.42 次索赔）下降到每季度 3.22 次索赔（95%CI，每季度 3.21-3.24 次索赔），下降了 5.3%，但利用率构成的变化，包括胰岛素使用的增加，与患者费用的额外增加有关。
在这项针对 T2D 患者的队列研究中，达到 65 岁时（大多数人开始参加医疗保险）的支出增加与医疗保险部分 D 的保险覆盖缺口和灾难性覆盖阶段的患者共同保险有关。65 岁时患者的成本负担增加和整体 T2D 药物利用率的适度下降表明，随着 T2D 患者进入医疗保险，非依从性和糖尿病并发症的潜在风险可能会增加。
