Tsang Chi Chun Steve, Zhang Xiangjun, Ellis Ashley, Wang Junling
Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN 38163, United States.
J Pharm Health Serv Res. 2025 Sep 12;16(3):rmaf017. doi: 10.1093/jphsr/rmaf017. eCollection 2025 Sep.
The Centers for Medicare and Medicaid Services tested the Part D Senior Savings Model (the 'PDSS Model') from 2021 to 2023, capping insulin cost-sharing at $35/month for Medicare beneficiaries in participating plans. The objective of the study was to assess the PDSS Model's effects on various categories of healthcare costs.
This study analysed the US Medical Expenditure Panel Survey (2020-2021). Study outcomes included costs for insulin, all medications, health services, and overall healthcare. Costs were calculated from patient (out-of-pocket) and healthcare sector perspectives. A difference-in-differences approach was implemented using generalized linear regression to compare cost changes from 2020 to 2021 between Medicare beneficiaries aged 65 and older and near-elderly non-Medicare individuals with private insurance.
Compared to non-Medicare patients, Medicare beneficiaries in general experienced higher reductions in out-of-pocket costs over time: 29% for insulin (cost ratio [CR] = 0.71, 95% confidence interval [CI] = 0.56-0.90), 66% for health services (CR = 0.34, 95% CI = 0.26-0.44), and 49% for overall healthcare (CR = 0.51, 95% CI = 0.34-0.77). For total costs, Medicare beneficiaries had a 41% smaller increase in insulin costs (CR = 0.59, 95% CI = 0.39-0.90) and a 42% smaller increase in medication costs (CR = 0.58, 95% CI = 0.46-0.74). Medicare beneficiaries experienced a 73% greater increase in total health service costs (CR = 1.73, 95% CI = 1.09-2.77).
The PDSS Model was generally associated with reduced out-of-pocket insulin and other out-of-pocket healthcare costs among Medicare beneficiaries, highlighting the value of cost-saving models.
医疗保险和医疗补助服务中心在2021年至2023年期间对D部分老年人储蓄模式（“PDSS模式”）进行了测试，将参与计划的医疗保险受益人的胰岛素费用分摊上限设定为每月35美元。该研究的目的是评估PDSS模式对各类医疗费用的影响。
本研究分析了美国医疗支出小组调查（2020 - 2021年）。研究结果包括胰岛素、所有药物、医疗服务和总体医疗保健的费用。费用从患者（自付）和医疗保健部门的角度进行计算。采用广义线性回归的差分法来比较2020年至2021年65岁及以上医疗保险受益人与有私人保险的临近老年非医疗保险个人之间的费用变化。
与非医疗保险患者相比，医疗保险受益人总体上随着时间推移自付费用的减少幅度更大：胰岛素费用减少29%（成本比率[CR]=0.71，95%置信区间[CI]=0.56 - 0.90），医疗服务费用减少66%（CR = 0.34，95% CI = 0.26 - 0.44），总体医疗保健费用减少49%（CR = 0.51，95% CI = 0.34 - 0.77）。对于总费用，医疗保险受益人胰岛素费用的增加幅度小41%（CR = 0.59，95% CI = 0.39 - 0.90），药物费用的增加幅度小42%（CR = 0.58，95% CI = 0.46 - 0.74）。医疗保险受益人总医疗服务费用的增加幅度大73%（CR = 1.73，95% CI = 1.09 - 2.77）。
PDSS模式通常与医疗保险受益人自付胰岛素费用和其他自付医疗保健费用的减少相关，凸显了成本节约模式的价值。
