Impact of type 2 diabetes medication cost sharing on patient outcomes and health plan costs.
OBJECTIVES To study the association between cost sharing for diabetes medications, adherence, hospitalization rates, and healthcare costs, with relationship to patient risk. STUDY DESIGN A retrospective claims analysis of data from 35 large, private, self insured employers (2004 to 2012) METHODS We examined outcomes for 92,410 patients aged 18 to 64 years with a type 2 diabetes (T2D) diagnosis who filled at least 1 T2D prescription. First, we examined the relationship between adherence, measured as the proportion of days covered, and cost sharing, measured as the out of pocket cost to purchase a pre specified bundle of T2D prescriptions. We then examined the association between adherence and hospital days. Simulations showed the effect of increased cost sharing on adherence and inpatient utilization. RESULTS A $10 increase in out of pocket cost was associated with a 1.9% reduction in adherence (P .01) In turn, a 10% reduction in adherence was associated with a 15% increase in per patient hospital days (0.17 days; P .01) For the average plan, switching from low to high cost sharing reduced per patient medication costs by $242 and increased per patient hospitalization costs by $342, for a net increase of $100 in plan costs. Increases in per patient costs were greater for high risk patients, such as those with heart failure $1328) CONCLUSIONS Increased cost sharing for T2D medication was associated with reductions in pharmacy costs, but higher total costs for patients with T2D. This problem is particularly acute for patients with 1 or more cardiovascular comorbidities. The results suggest that increased diabetes cost sharing may hamper efforts to lower the total cost of diabetes care.
The American journal of managed care