Diabetes drug costs, different use by Medicaid or market enrollment


New data shows that people enrolled in Medicaid with diabetes in Colorado have better access to new drugs and incur fewer associated costs compared to patients with Marketplace plans.

Among patients with diabetes residing in Colorado, drug use across multiple drug classes was higher and drug costs were significantly lower for adults enrolled in Medicaid than for those on subsidized Marketplace plans, according to findings from a cross-sectional study.

The findings, published in Open JAMA Network, also found that “Marketplace-covered patients had a similar percentage of months with an active prescription as Medicaid-covered patients,” the authors wrote.

In 2017, the estimated national cost of diabetes was $327 billion, and as the prevalence of diabetes has increased over the past decades, the prices of diabetes medications have also increased.

Although the rising cost of insulin has captured national attention in recent years, data shows that between 2014 and 2019, the list price of diabetes medications and supplies increased by 58%, “a rate almost double that of the increase in the overall price of drugs during this period”. “, said the researchers.

“Prices of non-insulin diabetes medications increased at a faster rate than prices of insulin products (76% vs. 50%) during this period,” they added, noting that coverage rules Insurance policies can also impact patient access to diabetes medications and supplies.

An estimated 1.9 million people with diabetes are enrolled in Medicaid and Marketplace insurance plans following the implementation of the Patient Protection and Affordable Care Act (ACA) in 2010.

To assess usage patterns and costs of prescription drugs to treat diabetes among low-income people with Medicaid and patients with Marketplace insurance, investigators assessed anonymized database information from all payers of Colorado (APCD) merged with state Medicaid and Marketplace income data. programs.

All of the people included were between the ages of 19 and 64 and had incomes between 75% and 200% of the federal poverty level. Medication utilization was measured through documentation of prescription medication refills, while medication costs were defined as total and out-of-pocket costs.

Of those included in the study, 20,245 (88.8%) patients were eligible for Medicaid and 2,543 (11.2%) were eligible for Marketplace plans. Data was collected between 2014 and 2015. People eligible for Marketplace plans tended to be older, while Medicaid-eligible patients were more likely to be female.

The analyzes revealed:

  • Medicaid-eligible patients were significantly more likely than Marketplace-eligible patients to fill prescriptions for dipeptidyl peptidase 4 inhibitors (adjusted difference, -3.7%; 95% CI, -5.3 to -2, 1; PP
  • Overall rates of insulin use were similar in the 2 groups (adjusted difference, -2.3%; -5.1 to 0.5; P= .11).
  • Direct non-insulin drug costs were 84.4% to 95.2% lower and total costs were 9.4% to 54.2% lower in Medicaid than in Marketplace plans.
  • Direct insulin costs were 76.7% to 94.7% lower in Medicaid plans compared to Marketplace plans, while differences in total insulin costs were mixed.
  • The percentage of months of apparent active drug coverage was similar between the 2 groups for 4 of the 5 drug classes examined, with Marketplace-eligible patients having a greater percentage of months than Medicaid-eligible patients for sulfonylureas (adjusted difference, 5 .3%, 95% CI, 0.3%-10.4%; P= 0.04).

“Low out-of-pocket costs may reflect the better financial protection provided by Medicaid compared to subsidized private insurance (all market enrollees likely qualify for cost-sharing reductions under the ACA),” the statement issued. researchers’ hypothesis.

Despite some concerns raised by policymakers about the extent of Medicaid coverage relative to private insurance, the results of the current analysis showed that “this low-income, high-risk patient population for negative outcomes Health seemed to have better access to newer (and more expensive) medications in Medicaid than in Marketplace plans, and less of a financial burden to fill those prescriptions.

The Colorado APCD did not include substantial information on race and ethnicity, and as such, researchers were unable to assess whether patterns of care differed by subgroup. to another, which constitutes a limitation of the study. The data included was also from 2014 and 2015, which means it may not reflect current pricing or usage patterns. The information included was also representative of only one state.

Overall, the cost differences illustrated may have “important information for policy makers considering ACA or Medicaid policy changes that could impact adults with chronic conditions such as diabetes.” and quantify some of the current cost savings associated with Medicaid drug policies,” the authors concluded.


Khorrami P, Sinha MS, Bhanja A, Allen HL, Kesselheim AS and Sommers BD. Differences in diabetic prescription drug use and costs among patients with diabetes enrolled in the Colorado market and Medicaid plans, 2014-2015. JAMA Netw Open. Published online January 14, 2022. doi:10.1001/jamanetworkopen.2021.40371


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