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Insulin Fills and $35 Cost Sharing Under the Inflation Reduction Act

Compared with patients aged 60 to 64 years without Part D insurance, Medicare enrollees aged 65 to 74 years had more insulin fills, and more $35 cost shares of insulin fills, after implementation of the Inflation Reduction Act, researchers report. The “analysis examined changes in insulin fills between the end of 1 calendar year and the beginning of the next, a time when deductibles reset and many patients must pay out of pocket for care,” the authors conclude. “In contrast to the prior year, Medicare enrollees aged 65 to 74 years did not experience a decline in insulin fills between the end of 2022 and the beginning of 2023.”

Data for 14 milliion prescription fills from Sept. 2021 through Dec. 2022 (before the cost-sharing cap) and Jan. 2023 through Apr. 2023 (after the cost-sharing cap) were obtained from IQVIA’s National Prescription Audit of 92% of community pharmacies and 70% of mail-service and long-term care facility pharmacies. The associations between the Inflation Reduction Act and the number of insulin fills (primary outcome) and insulin fills with cost sharing of $35 or less (secondary outcome) for Medicare Part D beneficiaries were determined for Medicare enrollees aged 65 to 74 years with Part D insurance (affected by the cost-sharing cap) and people who were about to age into Medicare (aged 60-64 years without Part D insurance).

“Before 2023, trends in monthly insulin fills were similar among patients with Medicare Part D aged 65 to 74 years and patients without Medicare Part D aged 60 to 64 years,” the authors report. “Between December 2021 and January 2022, there was a parallel decline in insulin fills in both groups. However, between December 2022 and January 2023, the group with Medicare Part D did not show this decrease.…

“The mean number of monthly fills with cost sharing of $35 or less increased from 340,509 in September 2022 through December 2022 to 366,928 in January 2023 through April 2023 for Medicare enrollees and decreased from 242,733 to 220,867 for those without Medicare (adjusted difference-in-differences estimate, 49,515 [95% CI, 48,480-50,549] fills per month; P < .001).”

Source: JAMA