Medicaid Expansion and Utilization of Antihyperglycemic Therapies

Abstract

Certain antihyperglycemic therapies modify cardiovascular and kidney outcomes among patients with type 2 diabetes, but early uptake in practice appears restricted to particular demographics. We examine the association of Medicaid expansion with use of and expenditures related to antihyperglycemic therapies among Medicaid beneficiaries. RESEARCH DESIGN AND METHODSWe employed a difference-in-difference design to analyze the association of Medicaid expansion on prescription of noninsulin antihyperglycemic therapies. We used 2012-2017 national and state Medicaid data to compare prescription claims and costs between states that did (n 5 25) and did not expand (n 5 26) Medicaid by January 2014. RESULTSFollowing Medicaid expansion in 2014, average noninsulin antihyperglycemic therapies per state/1,000 enrollees increased by 4.2%/quarter in expansion states and 1.6%/quarter in nonexpansion states. For sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA), quarterly growth rates per 1,000 enrollees were 125.3% and 20.7% for expansion states and 87.6% and 16.0% for nonexpansion states, respectively. Expansion states had faster utilization of SGLT2i and GLP-1RA than nonexpansion states. Differencein-difference estimates for change in volume of prescriptions after Medicaid expansion between expansion versus nonexpansion states was 1.68 (95% CI 1.09-2.26; P < 0.001) for all noninsulin therapies, 0.125 (20.003 to 0.25; P 5 0.056) for SGLT2i, and 0.12 (0.055-0.18; P < 0.001) for GLP-1RA. CONCLUSIONSUse of noninsulin antihyperglycemic therapies, including SGLT2i and GLP-1RA, increased among low-income adults in both Medicaid expansion and nonexpansion states, with a significantly greater increase in overall use and in GLP-1RA use in expansion states. Future evaluation of the population-level health impact of expanded access to these therapies is needed.Over 34 million U.S. patients live with diabetes including an estimated 6 million enrolled in Medicaid (1). Metrics of income and health care access are key predictors of mortality among patients with diabetes (2). Unfortunately, there has been a resurgence of cardiovascular complications among young and middle-aged adults with diabetes in the U.S. (3).

The Association Between Medicaid Expansion and Diabetic Ketoacidosis Hospitalizations

“…The ACA Medicaid expansion was designed to address high uninsured rates among low-income adults who fall into the coverage gap. The findings of this study confirm and complement the earlier studies that found that the ACA Medicaid expansion was associated with improved care and control of diabetes [ 15 - 17 ].…”

Racial/ethnic and socioeconomic disparities in the use of newer diabetes medications in the Look AHEAD study

“…Previous studies have found that cost sharing, formulary restrictions and Medicaid expansion are associated with utilization of newer diabetes medications. 7 The relationship between insurance coverage and access to newer diabetes medications requires further study.…”

“… 4 , 5 Further, among patients with diabetes, minority race/ethnicity and lower socioeconomic status are associated with greater cost-limited access of diabetes medications. 6 , 7 …”

Use of Sodium-Glucose Cotransporter 2 Inhibitors and Glucagonlike Peptide-1 Receptor Agonists in Patients With Diabetes and Cardiovascular Disease in Community Practice

“…Given this accumulating evidence, multiple major societies have been updating recommendations in recent years with strong directives for the use of these glucose-lowering agents with proven cardiovascular benefits . Older studies demonstrated low early use of SGLT2i and GLP-1 RA . Whether uptake of these agents has improved with early adoption of these recommendations is unknown.…”