Benjamin D. Ukert (
Theodoros V. Giannouchos, University of Alabama at Birmingham, Birmingham, Alabama.
Health Aff (Millwood). 2024 Aug;43(8):1147-1155. doi: 10.1377/hlthaff.2023.01592.
In 2020, Colorado became the first state to cap out-of-pocket spending for insulin prescriptions, requiring fully insured health plans to cap out-of-pocket spending at $100 for a thirty-day supply. We provide the first evidence on the association of Colorado's Insulin Affordability Program with patient out-of-pocket spending, the amounts paid by plans per insulin prescription, and prescription filling. Using statewide claims data from the period 2018-21, we focused on the first two years that the copay cap law was in effect. We found that Colorado's Insulin Affordability Program was associated with significant reductions in out-of-pocket spending for insulin prescriptions, with the mean out-of-pocket payment per thirty-day supply falling nearly in half (from $62.59 to $35.64). Average plan payments increased slightly more ($31.39) than the decrease in out-of-pocket spending, as the total amount paid per prescription increased by about 1 percent. The average insulin user realized annual savings of $184, while the mean number of fills and the mean days' supply per year increased by 4.2 percent and 11.4 percent, respectively.
2020 年，科罗拉多州成为第一个设定胰岛素处方自付费用上限的州，要求全额投保的健康计划将 30 天供应量的自付费用上限设定为 100 美元。我们提供了科罗拉多州胰岛素可负担性计划与患者自付费用、计划为每笔胰岛素处方支付的金额以及处方配药之间关联的首批证据。我们使用了 2018-21 年期间的全州索赔数据，重点关注该共付上限法生效的头两年。我们发现，科罗拉多州胰岛素可负担性计划与胰岛素处方自付费用的显著降低相关联，每 30 天供应量的平均自付费用几乎减半（从 62.59 美元降至 35.64 美元）。由于每张处方的总支付金额增加了约 1%，因此计划支付的平均金额略有增加（31.39 美元），超过了自付费用的减少。平均每位胰岛素使用者每年节省 184 美元，而每年的平均配药量和供应天数分别增加了 4.2%和 11.4%。
