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Alexandria, Va. – In partnership with Inovalon, the Pharmacy Quality Alliance (PQA) is assessing the impact of the Medicare out-of-pocket cost cap for insulin on persistence to basal insulin. The analysis will use evaluate a large sample of Medicare Advantage beneficiaries using the PQA-endorsed Persistence to Basal Insulin health plan performance measure, comparing measure rates before and after the implementation of the cost cap.
The Inflation Reduction Act of 2022 includes provisions for people with Medicare to benefit from lower prescription drug costs. As of January 1, 2023, Medicare beneficiaries who receive insulin covered under Medicare Part D pay no more than $35 in out-of-pocket costs for a month’s supply.
While improved medication adherence is correlated to improved outcomes, the cost of insulin is a significant barrier for diabetic patients, contributing to a decrease in medication-taking behavior. Diabetes affects approximately one in 10 Americans and can lead to increased rates of heart disease, stroke and other complications.
The Persistence to Basal Insulin health plan performance measure evaluates the percentage of individuals 18 years and older who were treatment-persistent to basal insulin during a measurement year and is the first measure addressing insulin use in Medicare Part D Patient Safety Reports.
“Given the cost and burden of diabetes for patients and our health care system, this is an important opportunity to evaluate the correlation between recently enacted policy aimed at improving access to basal insulin and its real-world effects,” PQA CEO Micah Cost said.
“We are proud the Pharmacy Quality Alliance selected Inovalon as their data partner, as we maintain the nation’s largest real-time primary source healthcare dataset and advanced analytics to enable improved clinical outcomes and economics across the healthcare ecosystem,” Christie Teigland, VP of research science and advanced analytics at Inovalon, said. “The analysis with PQA will help determine where additional interventions are needed to support greater medication adherence and help patients navigate the complexities and costs of living with diabetes.”
Results from the analysis will be shared in early 2025. The project is supported by Eli Lilly and Company and Novo Nordisk.
