PDF(Pubmed)
Abstract：
UNASSIGNED: Many insulin users ration doses due to high out-of-pocket costs. Starting January 2020 with Colorado, 25 states and the District of Columbia enacted laws that cap insulin copayments.
UNASSIGNED: To estimate the association of Colorado\'s $100 copayment cap with out-of-pocket spending, medication adherence, and health care services utilization for diabetes-related complications.
UNASSIGNED: In this cohort study using Colorado\'s All-Payer Claims Database, nonelderly insulin users with type 1 diabetes were analyzed from January 2019 to December 2020. Outcome changes were compared in the prepolicy and postpolicy period among individuals continuously enrolled in state-regulated and non-state-regulated plans using difference-in-differences regressions. Subgroup analyses were conducted based on individuals\' prepolicy spending (low: never ≥$100 out-of-pocket vs high: ≥$100 out-of-pocket cost at least once). Data were analyzed from June 2023 to May 2024.
UNASSIGNED: Enrollment in state-regulated health insurance plans subject to the copayment cap legislation.
UNASSIGNED: Adherence to basal and bolus insulin treatment was evaluated using the proportion of days covered measure, out-of-pocket spending reflected prescription cost for a 30-day supply, and health care utilization for diabetes-related complications was identified using primary diagnosis codes from medical claims data.
UNASSIGNED: The panel included 1629 individuals with type 1 diabetes (39 096 person-months), of which 924 were male (56.7%), 540 (33.1%) had 1 or more comorbidities, and the mean (SD) age was 40.6 (15.9) years. Overall, the copayment cap was associated with out-of-pocket spending declines of $17.3 (95% CI, -$27.3 to -$7.3) for basal and $11.5 (95% CI, -$24.7 to $1.7) for bolus insulins and increases in adherence of 3.2 (95% CI, 0.0 to 6.5) percentage points for basal and 3.3 (95% CI, 0.3 to 6.4) percentage points for bolus insulins. Changes in adherence were associated with increases within the prepolicy high-spending group (basal, 9.9; 95% CI, 2.4 to 17.4 percentage points; bolus, 13.0; 95% CI, 5.1 to 20.9 percentage points). The policy was also associated with a mean reduction of -0.09 (95% CI, -0.16 to -0.02) medical claims for diabetes-related complications per person per month among high spenders, a 30% decrease.
UNASSIGNED: In this cohort study of Colorado\'s insulin copayment cap among individuals with type 1 diabetes, the policy was associated with an overall decline in out-of-pocket spending, an increase in medication adherence, and a decline in claims for diabetes-related complications only among insulin users who spent more than $100 in the prepolicy period at least once.
UNASSIGNED: To estimate the association of Colorado\'s $100 copayment cap with out-of-pocket spending, medication adherence, and health care services utilization for diabetes-related complications.
UNASSIGNED: In this cohort study using Colorado\'s All-Payer Claims Database, nonelderly insulin users with type 1 diabetes were analyzed from January 2019 to December 2020. Outcome changes were compared in the prepolicy and postpolicy period among individuals continuously enrolled in state-regulated and non-state-regulated plans using difference-in-differences regressions. Subgroup analyses were conducted based on individuals\' prepolicy spending (low: never ≥$100 out-of-pocket vs high: ≥$100 out-of-pocket cost at least once). Data were analyzed from June 2023 to May 2024.
UNASSIGNED: Enrollment in state-regulated health insurance plans subject to the copayment cap legislation.
UNASSIGNED: Adherence to basal and bolus insulin treatment was evaluated using the proportion of days covered measure, out-of-pocket spending reflected prescription cost for a 30-day supply, and health care utilization for diabetes-related complications was identified using primary diagnosis codes from medical claims data.
UNASSIGNED: The panel included 1629 individuals with type 1 diabetes (39 096 person-months), of which 924 were male (56.7%), 540 (33.1%) had 1 or more comorbidities, and the mean (SD) age was 40.6 (15.9) years. Overall, the copayment cap was associated with out-of-pocket spending declines of $17.3 (95% CI, -$27.3 to -$7.3) for basal and $11.5 (95% CI, -$24.7 to $1.7) for bolus insulins and increases in adherence of 3.2 (95% CI, 0.0 to 6.5) percentage points for basal and 3.3 (95% CI, 0.3 to 6.4) percentage points for bolus insulins. Changes in adherence were associated with increases within the prepolicy high-spending group (basal, 9.9; 95% CI, 2.4 to 17.4 percentage points; bolus, 13.0; 95% CI, 5.1 to 20.9 percentage points). The policy was also associated with a mean reduction of -0.09 (95% CI, -0.16 to -0.02) medical claims for diabetes-related complications per person per month among high spenders, a 30% decrease.
UNASSIGNED: In this cohort study of Colorado\'s insulin copayment cap among individuals with type 1 diabetes, the policy was associated with an overall decline in out-of-pocket spending, an increase in medication adherence, and a decline in claims for diabetes-related complications only among insulin users who spent more than $100 in the prepolicy period at least once.
摘要：
■由于自付费用高，许多胰岛素使用者配给剂量。从2020年1月开始，科罗拉多州，25个州和哥伦比亚特区颁布了限制胰岛素共付额的法律。
■要估算科罗拉多州100美元共付额上限与自费支出的关联，药物依从性,和医疗保健服务对糖尿病相关并发症的利用。
■在这项使用科罗拉多州所有付款人索赔数据库的队列研究中，我们分析了2019年1月至2020年12月期间患有1型糖尿病的非老年胰岛素使用者.在政策前和政策后，使用差异差异回归比较了连续参加国家监管和非国家监管计划的个人的结果变化。根据个人的政策前支出进行亚组分析（低：从不≥$100自付与高：至少一次≥$100自付费用）。数据从2023年6月到2024年5月进行了分析。
■参加受国家监管的健康保险计划，但须遵守共付额上限立法。
■对基础和推注胰岛素治疗的依从性使用覆盖天数的比例来评估，自费支出反映了30天供应的处方成本，使用来自医疗索赔数据的主要诊断代码确定糖尿病相关并发症的医疗保健利用。
■该小组包括1629名1型糖尿病患者（39096人-月），其中924人为男性（56.7%），540（33.1％）有1种或更多种合并症，平均（SD）年龄为40.6（15.9）岁。总的来说,共付额上限与基础胰岛素和推注胰岛素的自付支出下降17.3美元(95%CI,-27.3美元至-7.3美元)和11.5美元(95%CI,-24.7美元至1.7美元)相关,以及基础胰岛素和推注胰岛素的依从性增加3.2(95%CI,0.0~6.5)个百分点和3.3(95%CI,0.3~6.4)个百分点。依从性的变化与政策前高支出群体的增加相关(基础，9.9；95%CI，2.4至17.4个百分点；推注，13.0；95%CI，5.1至20.9个百分点）。该政策还与高支出者每人每月平均减少-0.09（95％CI，-0.16至-0.02）的糖尿病相关并发症的医疗索赔有关，减少30%。
■在这项关于科罗拉多州1型糖尿病患者的胰岛素共付额上限的队列研究中，该政策与自付支出的整体下降有关，药物依从性的增加，仅在保单前至少花费超过100美元的胰岛素使用者中，糖尿病相关并发症的索赔减少。
■要估算科罗拉多州100美元共付额上限与自费支出的关联，药物依从性,和医疗保健服务对糖尿病相关并发症的利用。
■在这项使用科罗拉多州所有付款人索赔数据库的队列研究中，我们分析了2019年1月至2020年12月期间患有1型糖尿病的非老年胰岛素使用者.在政策前和政策后，使用差异差异回归比较了连续参加国家监管和非国家监管计划的个人的结果变化。根据个人的政策前支出进行亚组分析（低：从不≥$100自付与高：至少一次≥$100自付费用）。数据从2023年6月到2024年5月进行了分析。
■参加受国家监管的健康保险计划，但须遵守共付额上限立法。
■对基础和推注胰岛素治疗的依从性使用覆盖天数的比例来评估，自费支出反映了30天供应的处方成本，使用来自医疗索赔数据的主要诊断代码确定糖尿病相关并发症的医疗保健利用。
■该小组包括1629名1型糖尿病患者（39096人-月），其中924人为男性（56.7%），540（33.1％）有1种或更多种合并症，平均（SD）年龄为40.6（15.9）岁。总的来说,共付额上限与基础胰岛素和推注胰岛素的自付支出下降17.3美元(95%CI,-27.3美元至-7.3美元)和11.5美元(95%CI,-24.7美元至1.7美元)相关,以及基础胰岛素和推注胰岛素的依从性增加3.2(95%CI,0.0~6.5)个百分点和3.3(95%CI,0.3~6.4)个百分点。依从性的变化与政策前高支出群体的增加相关(基础，9.9；95%CI，2.4至17.4个百分点；推注，13.0；95%CI，5.1至20.9个百分点）。该政策还与高支出者每人每月平均减少-0.09（95％CI，-0.16至-0.02）的糖尿病相关并发症的医疗索赔有关，减少30%。
■在这项关于科罗拉多州1型糖尿病患者的胰岛素共付额上限的队列研究中，该政策与自付支出的整体下降有关，药物依从性的增加，仅在保单前至少花费超过100美元的胰岛素使用者中，糖尿病相关并发症的索赔减少。
