Evaluating Impact of Medicare Cost Cap for Insulin on Patient Treatment

Diabetes is a growing public health problem that affects more than 34 million U.S. and is the seventh leading cause of death in the U.S. Insulin is the mainstay treatment in helping patients manage their condition. Studies have reported low adherence and persistence to insulin therapy resulting in poor health outcomes including increased risk of complications such as heart disease and stroke, higher mortality, and reduced quality of life.

Historically, the cost of insulin has been a barrier to care for many patients, contributing to a lack of medication adherence. Under the Inflation Reduction Act, 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 as of January 1, 2023. Inovalon and the Pharmacy Quality Alliance (PQA) have partnered to analyze differences in medication-taking behavior following the onset of the cost cap.

Partnering with PQA to Improve Access to Basal Insulin

This study represents the first evaluation of the impact of the IRA drug cost cap   for insulin on persistence to basal insulin. Persistence is defined as continuing the treatment for the duration prescribed by a healthcare provider. Using the PQA-endorsed Persistence to Basal Insulin (PST-INS) health plan performance measure, the study will compare measure rates before and after the implementation of the cost cap in a large, nationally representative sample of Medicare Advantage (MA) beneficiaries.

Inovalon was uniquely positioned to support PQA in this study using our up-to-date primary source MA data. This nationally representative sample of MA plans provides current data for the entire first year of implementation of the price cap, allowing a timely and reliable analysis of the impact on access and persistence to treatment with insulin by comparing to medication behaviors in the year prior to implementation.

The analysis with PQA will help determine the extent to which lowering the cost of life-saving therapies increases adherence to prescribed treatments or whether there are additional barriers related to other social risk factors to address in order to support greater medication adherence and help patients navigate the complexities and costs of living with diabetes.

Stay Tuned

Results from the analysis will be shared in late 2024 to early 2025. Subscribe to our newsletter to make sure you get our latest research, news, and key updates.

In the meantime, explore Inovalon’s published research articles, powered by our extensive primary source healthcare dataset and analytics solutions that 19 out of the top 25 global pharmaceutical companies¹ already rely on.

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¹ Top 25 pharma companies based on “2023 Pharm Exec Top 50 Companies,” June 10, 2023. Inovalon internal reporting. April 2024.