Developing a provider-facing intervention to address cost-related medication restrictions and improve medication use in patients with type 2 diabetes

项目总结/摘要 降血糖药物的处方和依从性越来越受到健康的驱动 保险因素，如高自付药物费用和限制使用的处方惯例（例如， 事先批准的要求）。这些类型的费用相关的药物限制（定义为高 共同负担、高免赔额、处方集限制）可能限制循证药物的适当使用， 特别是当处方集落后于迅速发展的证据基础时。例如，最近的证据表明， 表明SGLT-2抑制剂和GLP-1受体激动剂可降低心血管疾病（CVD）的风险 2型糖尿病和CV风险升高患者的事件和死亡率。如果与费用有关的药物 限制限制了这些患者使用循证指南推荐的治疗， 最终导致更糟糕的健康结果。这些政策还可能增加行政负担， 从业者和贡献提供者倦怠。本提案的目标是开发一个面向提供商的 干预措施，以解决与成本有关的限制，并改善2型糖尿病患者的药物使用。它 有3个具体目标：1）检查与费用相关的药物限制和启动之间的关联 2型糖尿病（T2 D）患者中新型二线降糖药物的使用和依从性 有和没有确定的心血管疾病，2）描述医疗保健经历的成本相关的限制 寻求处方降糖药物的供应商，以及他们如何应对这些限制， 3）开发和试点测试面向提供者的教育外展干预措施， 帮助解决与成本相关的限制，并改善降糖药物的最佳使用。这些 目标将得到职业发展计划的补充，该计划包括教学课程、参与 在研讨会上，并在Walid Gellad博士领导的优秀团队的指导下， 调查员，有成功指导K获奖者的记录。该计划填补了PI的重要空白 培训，并将生成试点数据，以形成后续R 01应用程序的基础，测试供应商是否- 面对教育外展干预可以改善降糖药物的循证使用 和2型糖尿病患者的临床结果。

Project Summary/Abstract The prescribing of, and adherence to, glucose-lowering medications is increasingly being driven by health insurance factors such as high out-of-pocket medication costs and formulary practices that restrict use (e.g. requirements for prior authorization). These types of cost-related medication restrictions (defined as high copayments, high deductibles, formulary restrictions) can limit appropriate use of evidence-based medications, especially when formularies lag behind a rapidly evolving evidence base. For example, recent evidence suggests that SGLT-2 inhibitors and GLP-1 receptor agonists reduce the risk of cardiovascular disease (CVD) events and mortality in patients with type 2 diabetes and elevated CV risk. If cost-related medication restrictions limit the use of evidence-based, guideline recommended therapies in these patients, it may ultimately result in worse health outcomes. Such policies can also increase administrative burden for the practitioner and contribute to provider burnout. The goal of this proposal is to develop a provider-facing intervention to address cost-related restrictions and improve medication use for patients with type 2 diabetes. It has 3 specific aims: 1) To examine the association between cost-related medication restrictions and initiation of, and adherence to, newer 2nd line glucose-lowering medications among patients with type 2 diabetes (T2D) with and without established CVD, 2) To describe the cost-related restrictions experienced by health care providers seeking to prescribe glucose-lowering medications, and how they respond to such restrictions in contemporary practice and 3) To develop and pilot test a provider-facing, educational outreach intervention to help address cost-related restrictions and improve the optimal use of glucose lowering medications. These aims will be complemented by a career development plan that incorporates didactic coursework, participation in workshops, and intensive mentorship under an outstanding team led by Dr. Walid Gellad, an R01-funded investigator with a track record of successfully mentoring K awardees. The plan fills important gaps in the PI’s training and will generate pilot data to form the basis of a follow-up R01 application testing whether a provider- facing educational outreach intervention can improve the evidence-based use of glucose lowering medications and clinical outcomes for patients with type 2 diabetes.