Diabetes Drugs Cost Less Under Medicaid vs Marketplace Plans in Colorado

Drugs used to treat diabetes were used more and costed less among Medicaid enrollees compared to those insured under ACA Marketplace plans in Colorado.

Authors conducted a cross-sectional study of 22,788 adult patients with diabetes who had incomes between 75% and 200% of the federal poverty level. Patients were enrolled in Colorado Medicaid or Marketplace plans during 2014 and 2015, and data was analyzed from September 2020 to April 2021.

Drug utilization and costs, including total costs and out-of-pocket costs, were the primary outcomes of the study. Researchers also analyzed number of months with an active prescription for diabetes medications that were not insulin.

Out of the full sample, 20,245 patients were enrolled in Medicaid, and 2543 patients had Marketplace coverage.

While insulin utilization was similar across both groups (adjusted difference, -2.3%; -5.1 to .5; P = .11), patients enrolled in Medicaid were “significantly more likely…to fill prescriptions for dipeptidyl peptidase 4 [DDP-4] inhibitors (adjusted difference, -3.7%; 95% CI, -5.3 to -2.1; P < .001) and sulfonylureas (adjusted difference, -6.6%; 95% CI, -8.9 to -4.3; P < .001).”

Findings also indicated that costs were lower for those covered by Medicaid.

“Out-of-pocket costs for noninsulin medications were 84.4% to 95.2% lower and total costs were 9.4% to 54.2% lower in Medicaid than in Marketplace plans,” authors noted. “Out-of-pocket costs for insulin were 76.7% to 94.7% lower in Medicaid than in Marketplace plans, whereas differences in total insulin costs were mixed.”

Annual copay costs for all insulin brands were higher on average among patients enrolled in Marketplace plans. Researchers noted that Marketplace plans were associated with 4-15 times higher total cost-sharing per prescription for most inulin brands, compared to Medicaid.

Patients enrolled in Marketplace plans had coverage for sulfonylureas for a greater percentage of months compared to those with Medicaid (adjusted difference, 5.3%; 95% CI, .3%-10.4%; P = .04). However, the percentage of months with medication coverage was similar between both groups for the other 4 classes noninsulin drugs that researchers accounted for (DDP-4 inhibitors, glucagon-like peptide 1 agonists, sodium-glucose transport protein 2 inhibitors, and metformin).

Metformin was the most used drug in both groups. The proportions of patients using a generic drug were similar among both Medicaid and Marketplace plans (adjusted difference, 1.5%; 95% CI, -1.3 to 4.2; P = .30), but patients with Marketplace coverage used brand-name prescriptions less commonly (adjusted difference, -4.7%; 95% CI, -6.6 to -2.7; P < .001).

“We also found that patients with diabetes enrolled in Medicaid were significantly more likely to be taking newer medications such as DPP-4 inhibitors than were those enrolled in Marketplace insurance plans,” authors wrote. “Thus, although policy makers have voiced concerns about the scope of coverage in Medicaid compared with private insurance, in our study, this patient population with low income and at high risk of negative health outcomes appeared to have better access to newer (and more expensive) medications in Medicaid than in Marketplace plans and less financial burden in filling those prescriptions.”

Reference:
Khorrami P, Sinha MS, Bhanja A. Differences in diabetic prescription drug utilization and costs among patients with diabetes enrolled in Colorado Marketplace and Medicaid plans, 2014-2015. JAMA Netw Open. 2022;5(1):e2140371. doi:10.1001/jamanetworkopen.2021.40371