States that expanded eligibility for Medicaid in 2014 and 2015 saw an immediate uptick in Medicaid prescriptions filled for diabetes treatments, suggesting the legislation played a direct role in improving access and adherence to those drugs.
Lead author Rebecca Myerson, PhD, MPH, and colleagues studied data from more than 96 million Medicaid prescription fills in the U.S. from 2008 through 2015, allowing them to compare the differences before some states changed their policies.
A total of 29 states plus Washington, D.C., opted to expand Medicaid eligibility for low-income patients in 2014 or 2015. Compared to states that didn’t, they saw an annual increase in Medicaid diabetes prescriptions by 30 per 1,000 residents aged 20 to 64. Notably, newer classes of medications—which tend to be more expensive but have additional clinical benefits—accounted for one-third of the increase.
“We observed larger estimates for the increases in fills in 2015 than in 2014,” Myerson et al. wrote in Health Affairs. “When we divided the quarterly increase in fills into an intercept and a slope, we found that the slope was positive and significant—which indicates that the changes after Medicaid eligibility expansions grew over time.”
The authors noted the cost of insulin has more than tripled since 2002 and prices of other diabetes medications have risen sharply in recent years, making it difficult for uninsured patients to afford them. High out-of-pocket costs have been linked to treatment nonadherence among diabetics, leading to an elevated risk of poor glycemic control.
“This study provides policy makers with new information about the potential benefits of continuing financial support for expansions of Medicaid eligibility,” the researchers wrote. “Our findings by drug class suggest that these expansions helped address some of the gaps in access to newer medications for low-income patients.”
Data were tracked at the age-sex-state level, rather than for specific individuals over time. Another limitation of the study was the lack of information on ethnicity and race, as well as nonretail and mail-order prescriptions.
Still, Myerson and coauthors believe their study highlights a benefit of Medicaid expansion. They added another paper showed a decline in diabetes-related hospitalizations after such policies were enacted in states with previously high uninsured populations.
“Improvements in population health that are attributable to improved access to diabetes treatment, including the timely treatment of early-stage disease, could also justify some of the cost of expanding Medicaid,” Myerson et al. wrote. “Our study provides new evidence that the increases in treatment associated with Medicaid eligibility expansions can grow over time.”
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.