Projected Impact of the Medicare Part D Senior Savings Model on Diabetes-Related Health and Economic Outcomes Among Insulin Users Covered by Medicare

Abstract

OBJECTIVE The Medicare Part D Senior Savings Model (SSM) took effect on 1 January 2021. In this study we estimated the number of beneficiaries who would benefit from SSM and the long-term health and economic consequences of implementing this new policy. RESEARCH DESIGN AND METHODS Data for Medicare beneficiaries with diabetes treated with insulin were extracted from the 2018 Medical Expenditure Panel Survey. A validated diabetes microsimulation model estimated health and economic impacts of the new policy for the 5-year initial implementation period and a 20-year extended policy horizon. Costs were estimated from a health system perspective. RESULTS Of 4.2 million eligible Medicare beneficiaries, 1.6 million (38.3%) would benefit from the policy, and out-of-pocket (OOP) costs per year per beneficiary would decrease by 61% or $500 on average. Compared with non-White subgroups, the White population subgroups would have a higher proportion of SSM enrollees (29.6% vs. 43.7%) and a higher annual OOP cost reduction (reduction of $424 vs. $531). Among the SSM enrollees, one-third (605,125) were predicted to have improved insulin adherence due to lower cost sharing and improved health outcomes. In 5 years, the SSM would 1) avert 2,014 strokes, 935 heart attacks, 315 heart failure cases, and 344 end-stage renal disease cases; 2) gain 3,220 life-years and 3,381 quality-adjusted life-years (QALY); and 3) increase insulin cost and total medical cost by $3.5 billion and $2.8 billion. In 20 years, the number of avoided clinical outcomes, number of life-years and QALY gained, and the total and insulin cost would be larger. CONCLUSIONS The Medicare SSM may reduce the OOP costs for approximately one-third of the Medicare beneficiaries treated with insulin, improving health outcomes via increased insulin adherence. However, the SSM will also increase overall Medicare spending for insulin and overall medical costs, which may impact future premiums and benefits. Our findings can inform policy makers about the potential impact of the new Medicare SSM.

5‐Year simulation of diabetes‐related complications in people treated with tirzepatide or semaglutide versus insulin glargine

“…We have externally validated the BRAVO model against a large number of global diabetes trials and calibrated the model to a nationally representative sample of individuals with type 2 diabetes in the United States 26,27 . The BRAVO simulation model was previously used for several research purposes, including trial simulation, program evaluation and cost‐effectiveness analysis 23,28,29 . Detailed descriptions of the model were well described in a previous paper 24 …”

“…26,27 The BRAVO simulation model was previously used for several research purposes, including trial simulation, program evaluation and cost-effectiveness analysis. 23,28,29 Detailed descriptions of the model were well described in a previous paper. 24 We used the BRAVO diabetes model to simulate the 5-year study outcomes for the five study arms, using the SURPASS-2 trial population as the target population.…”

“…We assumed that tirzepatide reduced the risk of cardiovascular complications under a similar mechanism as other GLP-1 receptor agonist classes. To predict cardiovascular outcomes of our study medications accurately, we have tested this hypothesis by validating and calibrating the BRAVO model against four 29 CVOTs for GLP-1 receptor agonists classes (including ELIXA, LEADER, SUSTAIN 6 and EXSCEL). 11,[30][31][32] We extracted baseline characteristics of the study subjects and clinical efficacies of the included treatments in reducing risk factors (i.e.…”

Assessing—and Extending—California’s Insulin Manufacturing Initiative

“…3 Rationing of this sort was predicted to increase instances of stroke, myocardial infarction, heart failure, and end-stage renal disease in persons with diabetes. 4 Preventing such rationing by making insulin cheaper could consequently save tens of thousands of quality-adjusted life-years. 3 Current federal proposals-such as capping co-payments for the neediest persons with diabetes-do not reduce the overall prices paid for treatment and therefore may not ultimately be cost-effective.…”

“…One recent analysis from National Health Interview Survey data found that 1.3 million Americans have rationed insulin in the past year, specifically due to high prices . Rationing of this sort was predicted to increase instances of stroke, myocardial infarction, heart failure, and end-stage renal disease in persons with diabetes . Preventing such rationing by making insulin cheaper could consequently save tens of thousands of quality-adjusted life-years .…”