Estimating the Impact of the Medicare Part D Senior Savings Model on Expenses for Insulin Users on Medicare


A simulation model assesses the projected impact of the Medicare Part D Senior Savings Model on healthcare spending and outcomes among patients covered by Medicare using insulin.

A new study presented at the American Diabetes Association’s 81st Scientific Sessions (ADA 2021) details the projected impact of Medicare Part D Senior Savings Model (SMM) on diabetes-related health expenses and economic outcomes among patients using insulin covered by Medicare.

With rising costs of medications a focus at ADA 2021, the University of Florida College of Pharmacy-led study suggests the Medicare Part D SSM would provide relief to more than 1.2 million insulin users and also indicates use of the savings model could reduce the risk of complications in this patient population.

With an overall interest in the cost-effectiveness of diabetes treatments, Hui Shao, MD, PhD, an Assistant Professor at the University of Florida College of Pharmacy, designed multiple studies presented at ADA 2021 designed to explore how the cost of diabetes management has changed in recent years, including a study assessing the cost-effectiveness of newer glucose-lowering agents to older agents. The current study was designed to evaluate the impact of the Medicare Part D SSM on clinical and economic outcomes among Medicare insulin users.

To do so, the investigators designed their study to use data from the 2015-2016 iteration of the National Health and Nutrition Examination Survey (NHANES) and inputting this information into the Building, Relating, Validating, Assessing Outcomes (BRAVO) Diabetes microsimulation model with the specific aim of simulating the impact of the savings model on diabetes complications, quality0adjusted years of life (WALY), and medical costs.

Results of the investigators’ analysis suggested 1.29 million insulin users covered by Medicare were projected to be eligible for Medicare Part D SSM in 2021. Results of the model suggest the SSM insulin policy was associated with relative risk reductions of 5.61% for stroke, 3.27% for angina, 3.79% for MACE, and 3.49% for cardiovascular mortality at 5 years.

Over 5 years, the simulation model suggested SSM was projected to increase $2.0 billion in medical costs, which correlates to $1573 per person, with a gain of 7750 QALYs added (ICER: $157,300 per QALY). Over 20 years, the simulation model suggested the Medicare Part D SSM was associated with an additional $.5 billion in medical costs with an increased QALYs by 72,095 (ICER: $57,900 per QALY). Based on these calculations, investigators suggest the policy would need to be in place for longer than a 5-year period to reduce costs among this patient population.

For more on this study and the potential impact of the Medicare Part D SSM on Medicare patients using insulin, Endocrinology Network reached out to Shao and that conversation is the subject of this ADA 2021 House Call.

This study, “Projected Impact of the Medicare Part D Senior Savings Model (SSM) on Diabetes-Related Health and Economic Outcomes among Insulin Users Covered by Medicare,” was presented at ADA 2021.

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