Researchers assessed data from nearly 130,000 people who began using Medicare at age 65. When they enrolled in Medicare, their quarterly out-of-pocket costs for diabetes drugs went up by an average of $23. For those in the 95th percentile of spending, costs went up by about $56 per quarter.
This increased cost resulted in a 5.3 percent reduction in the number of diabetes drug claims per quarter. However, the research also noted that insulin use increased, leading to higher overall patient costs.
According to the study, before the age of 65, most people with health insurance are enrolled in commercial plans that, unlike Medicare Part D, offer out-of-pocket maximums and no coverage gap. “Coupled with provisions to reduce drug price growth and increase eligibility for the low-income subsidy for Part D, a substantial decrease in patient cost burden for medications is expected,” the researchers wrote. With the reduced out-of-pocket costs, the research team noted that patients have better adherence to their diabetes management medications, including insulin use.
Initial evidence on the effects of the 2023 $35 insulin cap indicates that more people filled insulin prescriptions. “This aligns with earlier evidence, which has shown that reductions in insulin OOP [out-of-pocket] costs are expected to lead to improved insulin adherence and large reductions in strokes, heart attacks, heart failure, and end-stage kidney disease,” the research team wrote..
