Margaret S. Colby

Treatment approach and HbA1c control among US adults with type 2 diabetes: NHANES 1999-2004

ABSTRACT Objective: To examine the distribution of diabetic medications among adults with type 2 diabetes, and the association between glucose control and treatment approach in the US population. Methods: Interview and prescription medication data from the 1999–2004 National Health and Nutrition Examination Survey (NHANES) were used to determine the treatment approach for US adults with type 2 diabetes. Mean glycosylated hemoglobin (HbA1c) and the proportion of adults meeting recommended guidelines for glucose control were estimated for each treatment approach. The most important study limitation was that participants were not asked what type of diabetes they had. Among adults with diabetes, a classification algorithm was used to identify those with type 2 diabetes. Results: During 1999–2004, approximately 60% of adults with type 2 diabetes used oral agents only to manage their diabetes. The distribution of oral treatment therapies changed over time (p < 0.01); the most prevalent treatment shifted from sulfonylurea monotherapy in 1999–2000 (23.0%) to any oral agent regimen containing thiazolidinedione (TZD) in 2003–2004 (21.4%). Overall, only 52.2% of adults with type 2 diabetes met the American Diabetes Association (ADA) goal for HbA1c control (<7.0%) during 1999–2004. Across oral agent treatment categories, the proportion with HbA1c controlled at the 7.0 level was significantly lower (p < 0.01) for those on triple therapy (31.9%) (TZD, sulfonylurea, and metformin), than those on metformin alone (62.2%), likely reflecting a progressive treatment approach of prescribing additional medications for those with uncontrolled HbA1c levels. Conclusions: Use of multiple oral agents among adults with type 2 diabetes has increased (sulfonylurea and metformin, p = 0.03, triple therapy, p = 0.02). However, nearly half of adults with type 2 diabetes have HbA1c levels above ADA guidelines for control, indicating that available treatments could be used more optimally, and new diabetic agents may be needed.

Out-of-Pocket Drug Costs and Drug Utilization Patterns of Postmenopausal Medicare Beneficiaries with Osteoporosis

BACKGROUND The Medicare Part D coverage gap has been associated with lower adherence and drug utilization and higher discontinuation. Because osteoporosis has a relatively high prevalence among Medicare-eligible postmenopausal women, we examined changes in utilization of osteoporosis medications during this coverage gap. OBJECTIVES The purpose of this study was to investigate changes in out-of-pocket (OOP) drug costs and utilization associated with the Medicare Part D coverage gap among postmenopausal beneficiaries with osteoporosis. METHODS This retrospective analysis of 2007 pharmacy claims focuses on postmenopausal female Medicare beneficiaries enrolled in full-, partial-, or no-gap exposure standard or Medicare Advantage prescription drug plans (PDPs), retiree drug subsidy (RDS) plans, or the low-income subsidy program. We compared beneficiaries with osteoporosis who were taking teriparatide (Eli Lilly and Company, Indianapolis, Indiana) (n = 5657) with matched samples of beneficiaries who were taking nonteriparatide osteoporosis medications (NTO; n = 16,971) or who had other chronic conditions (OCC; n = 16,971). We measured average monthly prescription drug fills and OOP costs, medication discontinuation, and skipping. RESULTS More than half the sample reached the coverage gap; OOP costs then rose for teriparatide users enrolled in partial- or full-gap exposure plans (increase of 121% and 186%;

Promising therapies, prohibitive costs: a qualitative assessment of the effects of the Medicare Part D doughnut hole on access to costly cancer medications

300 and

Value for the Money Spent? Exploring the Relationship Between Medicaid Costs and Quality

349) but fell for those in no-gap exposure PDPs or RDS plans (decrease of 49% and 30%;

Medication Discontinuation and Reinitiation Among Medicare Part D Beneficiaries Taking Costly Medications

131 and

Evaluation of Healthy San Francisco

40). OOP costs for beneficiaries in partial- or full-gap exposure PDPs increased >120% (increase of

Value for the Money Spent? Exploring the Relationship Between Medicaid Costs and Quality. Washington, DC: Mathematica Policy Research

144 and

Lessons from California's Public Reporting on Pathways to Health Insurance Coverage

176) in the NTO group and nearly doubled for the OCC group (increase of

Health Care Utilization Among Children Enrolled in Medicaid and CHIP via Express Lane Eligibility

124 and

Value for the Money Spent? Exploring the Relationship Between Expenditures, Insurance Adequacy, and Access to Care for Publicly Insured Children. Maternal and Child Health Journal, vol. 16, supplement 1

151); these OOP costs were substantially lower than those for teriparatide users. Both teriparatide users and NTO group members discontinued or skipped medications more often than persons in the OCC group, regardless of plan or benefit design. CONCLUSION Medication discontinuation and OOP costs among beneficiaries with osteoporosis were highest for those enrolled in Part D plans with a coverage gap. Providers should be aware of potential cost-related nonadherence among Medicare beneficiaries taking osteoporosis medications.