Benefits and Cost of a $35 Insulin Cost-Sharing Cap for Medicare Patients

BACKGROUND: To improve insulin affordability, Congress is considering capping insulin cost-sharing to $35 per 30-day supply for Medicare patients. The potential benefits and cost of this cap are unclear. Additionally, it is unknown whether the benefits of this cap would vary between Medicare patients with type 1 versus type 2 diabetes. METHODS: We conducted a cross-sectional analysis of the IQVIA Longitudinal Prescription Database, which reports prescriptions dispensed from 92% of U.S. pharmacies, and the Optum Clinformatics Data Mart, a national claims database from Medicare Advantage patients. The IQVIA analysis included patients who only had dispensed insulin prescriptions paid by Medicare in 2019. We estimated the proportion of Medicare patients who would benefit from an insulin cost-sharing cap of $35 per 30-day supply. Among these patients, we calculated the mean annual decrease in insulin out-of-pocket spending. We summed this decrease across patients to estimate the cap's cost to the federal government. The Optum analysis included Medicare Advantage patients with diabetes and at least 1 dispensed insulin prescription in 2019. We used linear regression to compare the proportion of patients who would benefit from a $35 cap and annual savings among these patients by diabetes type, adjusting for demographic characteristics and payer type. RESULTS: The IQVIA analysis included 2,227,229 patients who only had dispensed insulin prescriptions paid by Medicare in 2019. Mean (SD) age was 69.2 (11.4) years. The $35 cap would benefit 887,051 (39.0%) of patients, lowering annual insulin out-of-pocket spending by $338, from $687 to $349. Across all patients in the sample, aggregate savings (i.e., the cap's cost to the federal government) would be $299,402,402, or a mean of $134.4 per patient. Among the 60,300 Medicare Advantage patients in the Optum Analysis, mean age was 72.6 (9.3) years; 2,686 (4.5%) had type 1 diabetes and 57,614 (95.6%) had type 2 diabetes. The $35 cap would benefit a higher proportion of patients with type 1 diabetes (64.0%) compared with patients with type 2 diabetes (59.4%). Among patients with type 1 diabetes who would benefit from the cap, annual savings would be greater ($284) compared with their counterparts with type 2 diabetes ($231; p<.001 in adjusted analyses for all comparisons). CONCLUSIONS: A $35 insulin cost-sharing cap would benefit a sizable proportion of Medicare patients using insulin and may particularly lower out-of-pocket spending for patients with type 1 diabetes. The estimated cost of this cap to the federal government would be $134.4 per Medicare patient using insulin.

A Virtual Companionship Intervention Reduces Loneliness During the COVID-19 Pandemic

Loneliness and social isolation are established risk factors for many clinical conditions yet few scalable interventions exist. Papa Inc. is a national service that pairs older adults with “Papa Pals” (empathetic, laypeople) who provide companionship and assistance with everyday tasks. Participants have free access if their Medicare Advantage plan offers it. During the COVID-19 pandemic, Papa provided virtual companionship visits via telephone or video. This study evaluated the impact of virtual companionship visits on loneliness status (UCLA 3-item Loneliness Scale) during the COVID-19 pandemic. The sample (N=894) included adults ages 65+ who identified as lonely at baseline and who completed at least one virtual visit between March 18, 2020 and December 31, 2020. Virtual visits were classified into four categories based on participants’ total number of visit minutes: Low (124 ave min), Medium Low (ML) (305 ave min), Medium High (MH) (567 ave min), and High (1360 ave min). Lonely and severely lonely participants engaged a mean of 573 and 673 minutes in the program, respectively. Improvement in loneliness status was associated with greater use of minutes for the ML and MH participants compared to Low participants (ML OR: 1.46 95CI: 1.00 - 2.11, MH OR 1.65 95CI: 1.13 - 2.40). These findings indicate that a virtual companionship intervention can be an impactful and scalable tool for older adults who want to age at home and have limited social support, especially during the uncertain COVID landscape. Further research is warranted to understand persistent loneliness.

Medical Complexity, Mortality Among High-Cost Medicare Advantage Enrollees: Palliative, Hospice Implications

Older adults with high medical spend require tailored interventions and care delivery to meet their complex needs. Palliative is a high-value solution for high-cost patients because it provides relief from the symptoms, pain, and stress associated with multiple conditions. Likewise, other high-cost patients may be closer to end-of-life and therefore benefit from hospice care. For Accountable Care Organizations (ACOs) and hospitals to implement palliative care, these programs must identify and target the high-need patient populations. This study explored patterns of spending and mortality across 4 years (2016-2019) using claims from 1,701,647 patients continuously enrolled in UnitedHealth Group Medicare Advantage (mean age=73.7; S.E.=0.01). Patients with healthcare spend in the top decile were segmented into three subgroups based on health conditions and spend patterns. Analyses identified a subgroup of patients (mean age=76.6; S.E.=0.04), with the highest rate of mortality, and significantly more chronic conditions and frailty, indicating their cost and mortality was driven by medical complexity. Odds ratios from a multinomial logistic model tie blood formulation drugs (OR XX), medicative procedures (OR XX), and nonhospital-based care (OR XX) to members of this subgroup may be connected to short-term mortality. There is a critical need to identify patients who stand to benefit from palliative and end of life care, this is particularly true for high-cost high-need patients. Our study suggests that patterns of medical complexity and morality within high-cost patient subpopulations can be used to identify high-cost patients who would benefit from palliative or hospice care.