MONDAY, Aug. 6, 2018 — People with diabetes face a host of expenses related to their disease, but some relief may now be available in states that expanded Medicaid eligibility as part of the Affordable Care Act.
A new study reports that the number of prescriptions filled rose by up to 40 percent for insulin and other diabetes medications in states that expanded Medicaid eligibility in 2014 and 2015.
“We think that Medicaid expansion is helping to provide medications for people with diabetes, especially early stage diabetes,” said study author Rebecca Myerson.
“Medicaid expansion also appears to help increase access to newer medications, ensuring all patients have access to the same quality of medications,” she added.
Myerson is an assistant professor of pharmaceutical and health economics at the University of Southern California.
Diabetes is one of the top 10 causes of death, and is a risk factor for heart disease, the leading cause of death in the United States. Complications from diabetes can often be prevented with medications that lower blood sugar levels, the study authors noted.
But the researchers pointed out that not everyone gets all of the medications they need, and out-of-pocket costs are one reason why.
According to Krista Maier, vice president of public policy and strategic alliance for the American Diabetes Association, people with diabetes have 2.3 times higher health care costs than people without the disease.
“When people aren’t able to afford the care they need, they often forgo that care. When diabetes is inadequately managed, it can lead to deadly and devastating consequences. We want to make sure that people who need this care can afford it,” Maier said.
Although newer medications may carry important health benefits, they are often more expensive than older ones. For example, newer insulins cost about twice what older insulins do, the researchers said. And, there are many new drugs for diabetes. The number of medication categories for treating diabetes went from three to 11 since the early 1990s, the study authors added.
The Affordable Care Act (also known as ACA, or Obamacare) allows states to expand eligibility for Medicaid. Medicaid is government-funded insurance for people with low incomes. In states that have chosen to do so, there has been a drop in costs related to failure to follow prescription recommendations. There has also been improved access to primary care for newly insured people, the researchers reported.
To see what effect Medicaid expansion had on diabetes prescriptions, the investigators looked at states that expanded their Medicaid eligibility in 2014 and 2015. Twenty-nine states and the District of Columbia did so.
The researchers compared prescriptions filled between January 2008 and December 2013, to those between January 2014 and December 2015.
The number of prescription fills for insulin went up by 40 percent after the Medicaid expansions. The prescriptions for newer diabetes medications — such as Victoza, Trulicity, extended-release Glucophage, Invokana and Farxiga — rose 39 percent with Medicaid expansion.
Myerson said that before Medicaid expansion, only about 15 percent of low-income patients could get these newer prescriptions.
While some aspects of the ACA’s future are still being debated politically, Myerson noted that several states are asking voters to decide in November whether or not to expand Medicaid eligibility. She said the federal government-matching under the ACA will still be “generous” through 2020.
Maier pointed to what she called one troubling trend, however — Medicaid work requirements. She said some states are asking Medicaid recipients to work a specific number of hours a week or lose their health insurance. That means people who lose their jobs, who work jobs with fluctuating hours, or who miss work due to illness or medical visits could suddenly lose insurance.
“These requirements make it difficult to maintain Medicaid coverage,” she said.
The study was published in the August issue of Health Affairs.