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

项目总结 1型糖尿病(T1D)和2型糖尿病(T2D)影响着近3000万美国人。对两个人都是 对于T1D和T2D患者，严格的血糖控制可以降低微血管的风险(例如，失明， 截肢等。)和大血管(如心肌梗死)并发症， 最终降低终身医疗成本，提高生活质量。实现紧密性 在血糖控制方面，患者依赖各种药物和不同配方的胰岛素。为 T1D和胰岛素-使用T2D患者，胰岛素的标价从2007年到2018.1上涨了两倍多 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 对于制造商，标价用于确定患者的费用分摊金额。作为回应 为了应对胰岛素价格的上涨，科罗拉多州通过了一项立法，将自付胰岛素的成本限制在 每月100美元。虽然科罗拉多州是第一个通过这样一项政策的州，但有十几个州 各州和一项医疗保险试点计划也纷纷效仿，因此了解 立法/监管上限对胰岛素自付成本的影响。通过合作伙伴关系 科罗拉多大学和犹他大学的教职员工，我们建议评估这些影响 科罗拉多州关于胰岛素自付费用的立法上限。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)。使用链接的电子健康记录和 所有付款人的索赔数据来自科罗拉多州和犹他州，我们将进行差异中的差异 分析。通过差异分析，我们将比较利用率的变化和 在科罗拉多州实施自付上限前后的血糖控制 对照组(犹他州)正在经历 总体轨迹相同，但在分析期间没有受到政策变化的影响。 我们的提案将通过将电子健康记录和所有付款人索赔相结合来开辟新的天地 数据，这样我们不仅可以测量利用率，还可以测量下游的临床结果 血糖控制，这是一个仅从索赔数据中无法获得的变量。除了生成 关于胰岛素自付费用立法上限的影响的基本新知识，这 研究将生成试点数据，以支持未来关于关系的赠款申请 在自付上限和长期健康结果和支出之间，以及单独地， 这种政策变化对支付者的预算影响。我们这支队伍特别适合指挥 这项分析，当我们汇集处方药支付政策方面的专业知识时，准- 实验方法，糖尿病的治疗，以及科罗拉多州和犹他州联系的电子健康 记录和索赔数据库。

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.