Insulin treatment persistence varies among payers

Basal insulin persistence patterns vary significantly by payer within the U.S., according to a new study published in the March issue of Journal of Managed Care & Specialty Pharmacy.

The study, from Walgreens, is a retrospective observational study of type 2 diabetes patients aged ≥ 18 years who filled more than one prescription for the basal insulins glargine, detemir, or neutral protamine Hagedorn insulin [NPH]), between index period (January 2013 to June 2013), who were eligible for inclusion in the analysis. A one-year follow-up persistence was calculated and compared by payer segment, basal insulin types, and devices. It found that Medicare patients have the highest persistence rates and durations, as opposed to those paying with cash who had the lowest.

While several studies have examined insulin treatment persistence and associated outcomes, there is a lack of real-world data on insulin treatment persistence in various patient populations across different payer segments in the United States, according to Jenny Jiang, senior analyst at Walgreens and study co-author. 

Jiang

“This study provides a benchmark of basal insulin treatment persistence across different payers in the United States,” Jiang says. “Findings indicate that basal insulin persistence patterns are significantly different across different payer segments-commercial, Medicare, Medicaid, and cash-pay, basal insulin types-insulin glargine, insulin detemir, or NPH], and devices-pen versus vial/syringe. This information may be useful in developing targeted approaches to improve type 2 diabetes patients’ persistence with insulin treatment for better glycemic control that, in turn, should reduce these patients’ overall healthcare unitization and cost.”

This study provides new information on how various payer populations and treatment-related factors are associated with adherence to basal insulin treatments, according to Jiang.

“These findings may be used to design effective strategies for improving treatment adherence, and therefore glycemic control, in patients with type 2 diabetes,” she says.

For example, it may be beneficial to allow preferred formulary status for pen devices versus vials and for specific types of basal insulin that show better adherence levels, according to Jiang. “The study can also be utilized as a benchmark when assessing an organization’s overall basal insulin adherence when compared to the overall market,” she says. 

Quality of care improvements

This study can help managed care executives develop interventions to improve the quality of care for type 2 diabetes patients and reduce healthcare costs, according to Jiang.

“They should consider using the methodology from this study to measure and understand the differences in persistence to basal insulin,” she says. “The results of the study can serve as a benchmark comparison within each payer segment. This will be especially useful when developing targeted interventions to improve persistence such as benefit plan support for pen devices and lower value-based copays.”    

Based on the study, Jiang offers these three takeaways:

1.   Insulin persistence patterns are significantly different across different payer segments, basal insulin types, and devices.

2.   Higher persistence rate and duration were associated with Medicare versus cash-pay patients, use of insulin pens versus vial/syringe, and use of insulin glargine versus NPH.

3.   This information may be useful in developing targeted approaches to improve type 2 diabetes patients’ persistence with insulin treatment for better glycemic control and therefore lower healthcare costs.

“While diabetes is one of the most expensive chronic conditions in the U.S. today annually costing the nation approximately $245 billion, we can identify ways to influence medication access and persistence,” says Harry Leider, MD, MBA, FACPE, chief medical officer and group vice president, Walgreens.

Walgreens worked with Sanofi researchers Wenhui Wei, PhD, MS, MBA and Sohini Ganguli, PharmD, on this research and funding for the research.