Walid F. Gellad, MD, MPH, from the Veterans Affairs Pittsburgh Healthcare System, and colleagues retrospectively analyzed data from 1,061,095 Medicare Part D beneficiaries and 510,485 veterans aged 65 years or older with diabetes. The authors sought to identify the percentage of patients taking oral hypoglycemics, statins, and angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) who filled brand-name drug prescriptions and percentage of patients taking long-acting insulins who filled analogue prescriptions.
The researchers found that brand-name drug use in Medicare was two to three times that in the VA (oral hypoglycemics, 35.3 versus 12.7 percent; statins, 50.7 versus 18.2 percent; ACE inhibitors or ARBs, 42.5 versus 20.8 percent; and insulin analogues, 75.1 versus 27.0 percent). From the fifth to the 95th percentiles, adjusted hospital referral region (HRR)-level brand-name statin use ranged from 41.0 to 58.3 percent in Medicare and 6.2 to 38.2 percent in the VA. For each drug group there was lower brand-name drug use for the 95th-percentile HRR in the VA compared to the 5th-percentile HRR in Medicare. Medicare spending would have been $1.4 billion less in this population if brand-name drug use had matched that of the VA.
"Medicare beneficiaries with diabetes use two to three times more brand-name drugs than a comparable group within the VA, at substantial excess cost," the authors write.