PQA and Inovalon Evaluating Impact of Medicare Cost Cap for Insulin on Patient Persistence

The Pharmacy Quality Alliance (PQA) in partnership with Inovalon is evaluating the impact of the Medicare out-of-pocket cost cap for insulin on persistence to basal insulin. The analysis will use the PQA-endorsed Persistence to Basal Insulin (PST-INS) health plan performance measure to compare measure rates before and after the implementation of the cost cap in a large nationally representative sample of Medicare Advantage beneficiaries.

The Inflation Reduction Act of 2022 includes provisions for people with Medicare to benefit from lower prescription drug costs. As of January 1, 2023, Medicare beneficiaries who receive insulin covered under Medicare Part D pay no more than $35 in out-of-pocket costs for a month’s supply.

Diabetes affects approximately one in 10 Americans and can lead to increased rates of heart disease, stroke and other complications. Treatment with basal insulin is recommended for individuals that fail to meet glycemic targets. A large body of evidence has linked improved medication adherence to improved outcomes in patients with diabetes. However, the cost of insulin presents a significant burden to patients, contributing to a decrease in medication-taking behavior.

“This analysis will provide early insights into the impact of the insulin price cap on patient persistence,” PQA CEO Micah Cost, PharmD, MS, CAE, said. “Given the cost and burden of diabetes for patients and our health care system, this is an important opportunity to evaluate the correlation between recently enacted policy aimed at improving access to basal insulin and its real-world effects.”

PST-INS is a health plan performance measure that evaluates the percentage of individuals 18 years and older who were treatment-persistent to basal insulin during a measurement year. Patients are considered persistent if each of their insulin refills during the measurement year occurs within an empirically determined interval.

The PST-INS measure is included in the Medicare Part D Patient Safety Reports, which provide confidential rates to Part D plan sponsors, enabling them to monitor their own progress and to compare their performance to overall averages, as well as on the Medicare Part D display page for public reporting. This is the first measure addressing insulin use in Part D quality programs.

“We are proud the Pharmacy Quality Alliance selected Inovalon as their data partner, as we maintain the nation’s largest real-time primary source healthcare dataset and advanced analytics to enable improved clinical outcomes and economics across the healthcare ecosystem,” Christie Teigland, PhD, VP of Research Science and Advanced Analytics at Inovalon, said. “The analysis with PQA will help determine where additional interventions are needed to support greater medication adherence and help patients navigate the complexities and costs of living with diabetes.”

Results from the analysis will be shared in early 2025. This project is supported by Eli Lilly and Company and Novo Nordisk.