Effect of a State-Level Co-Payment Cap for Insulin on Utilization and Glycemic Control

州级胰岛素共同支付上限对利用和血糖控制的影响

• 批准号: 10571244
• 负责人: Kelly Elizabeth Anderson
• 金额: $ 10万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2023-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10571244
• 关键词: Effect; State; Level; Co; Payment

PROJECT SUMMARY Type 1 diabetes (T1D) and type 2 diabetes (T2D) impact nearly 30 million Americans. For both T1D and T2D patients, tight glycemic control can reduce the risk of microvascular (e.g., blindness, lower extremity amputations, etc.) and macrovascular (e.g., myocardial infarction) complications, ultimately reducing lifetime health care costs and improving quality of life. To achieve tight glycemic control, patients rely on various medications and different formulations of insulin. For T1D and insulin-using T2D patients, list prices for insulin more than tripled from 2007 to 2018.1 While the list price is not ultimately the amount paid by an insurer or the amount received by a manufacturer, the list price is used to determine cost sharing amounts for patients. In response to the rising cost of insulin, Colorado passed legislation to cap the out-of-pocket cost of insulin at $100 per month. While Colorado was the first state to pass such a policy, more than a dozen states and a Medicare pilot program have followed suit, making it important to understand the effects of legislative/regulatory caps on insulin out-of-pocket costs. Through a partnership of faculty from the University of Colorado and University of Utah, we propose to evaluate the effects of Colorado's legislative cap for insulin out-of-pocket costs. We will focus on two key outcomes: insulin utilization (Aim 1) and glycemic control (Aim 2). Using linked electronic health record and all-payer claims data from Colorado and Utah, we will conduct a difference-in-differences analysis. With a difference-in-differences analysis, we will compare the change in utilization and glycemic control before and after the implementation of the out-of-pocket cap in Colorado to changes in utilization and glycemic control in a comparison group (Utah) that is experiencing the same general trajectory, but was not exposed to the policy change during the period of analysis. Our proposal will break new ground by combining electronic health record and all-payer claims data so that we can not only measure utilization, but also the downstream clinical outcome of glycemic control, a variable not available from claims data alone. In addition to generating fundamental new knowledge on the effect of a legislative cap for insulin out-of-pocket costs, this research will generate pilot data that will support future grant applications on the relationship between out-of-pocket caps and long-run health outcomes and spending, and separately, the budget impact of such a policy change for payers. Our team is particularly well-suited to conduct this analysis, as we bring together expertise in prescription drug payment policy, quasi- experimental methods, treatment for diabetes, and the Colorado and Utah linked electronic health record and claims databases.

项目摘要 1型糖尿病（T1 D）和2型糖尿病（T2 D）影响近3000万美国人。为 T1 D和T2 D患者，严格的血糖控制可以降低微血管（例如，失明， 下肢截肢等）和大血管（例如，心肌梗塞）并发症， 最终降低终身医疗保健成本并提高生活质量。要实现紧 在血糖控制方面，患者依赖于各种药物和不同的胰岛素制剂。为 T1 D和使用胰岛素的T2 D患者，胰岛素的标价从2007年到2018年增加了两倍多。 虽然标价最终不是保险公司支付的金额或保险公司收到的金额， 制造商，定价用于确定患者的费用分摊金额。响应 由于胰岛素价格上涨，科罗拉多州通过立法，将胰岛素的自付费用限制在 每月100美元。虽然科罗拉多是第一个通过这一政策的州，但有十几个州 美国各州和医疗保险试点计划也纷纷效仿，这使得了解 立法/监管上限对胰岛素自付费用的影响。通过合作伙伴关系， 来自科罗拉多大学和犹他州大学的教师，我们建议评估的影响， 科罗拉多州的立法上限为胰岛素的自付费用。我们将重点关注两个关键成果： 胰岛素利用（目标1）和血糖控制（目标2）。使用联网电子健康记录， 所有付款人索赔数据从科罗拉多和犹他州，我们将进行差异中的差异 分析.通过差异中的差异分析，我们将比较利用率的变化， 在科罗拉多实施自付上限之前和之后， 在对照组（犹他州）中， 总体轨迹相同，但在分析期间没有受到政策变化的影响。 我们的提案将通过结合电子健康记录和所有付款人索赔来开辟新天地 数据，以便我们不仅可以测量利用率，而且还可以测量下游临床结果， 血糖控制，这是一个无法单独从索赔数据中获得的变量。除了生成 这是关于胰岛素自付费用立法上限影响的基本新知识 研究将产生试点数据，以支持未来的赠款申请的关系 自付上限和长期健康结果和支出之间的关系， 这种政策变化对支付者的预算影响。我们的团队特别适合进行 这种分析，因为我们汇集了处方药支付政策的专业知识，准- 实验方法，糖尿病治疗，以及与科罗拉多和犹他州相关的电子健康 记录和索赔数据库。