Projected Impact of the Medicare Part D Senior Savings Model on Diabetes-Related Health and Economic Outcomes Among Insulin Users Covered by Medicare

• DOI: 10.2337/dc21-2601
• Publication Date: 2022-06-14T19:31:47Z
• Authors: Hui Shao; Dawei Guan; Jingchuan Guo; Tianze Jiao; Yongkang Zhang; Jing Luo; Lizheng Shi; Vivian Fonseca; Joshua D. Brown
• Keywords: Beneficiary

OBJECTIVE The Medicare Part D Senior Savings Model (SSM) took effect on 1 January 2021. In this study we estimated the number of beneficiaries who would benefit from SSM and long-term health economic consequences implementing new policy. RESEARCH DESIGN AND METHODS Data for with diabetes treated insulin were extracted 2018 Medical Expenditure Panel Survey. A validated microsimulation model impacts policy 5-year initial implementation period a 20-year extended horizon. Costs system perspective. RESULTS Of 4.2 million eligible beneficiaries, 1.6 (38.3%) policy, out-of-pocket (OOP) costs per year beneficiary decrease by 61% or $500 average. Compared non-White subgroups, White population subgroups have higher proportion enrollees (29.6% vs. 43.7%) annual OOP cost reduction (reduction $424 $531). Among enrollees, one-third (605,125) predicted to improved adherence due lower sharing outcomes. 5 years, 1) avert 2,014 strokes, 935 heart attacks, 315 failure cases, 344 end-stage renal disease cases; 2) gain 3,220 life-years 3,381 quality-adjusted (QALY); 3) increase total medical $3.5 billion $2.8 billion. 20 avoided clinical outcomes, QALY gained, be larger. CONCLUSIONS may reduce approximately insulin, improving outcomes via increased adherence. However, will also overall spending costs, which impact future premiums benefits. Our findings can inform makers about potential SSM.