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Medicare Advantage vs Commercial Insurance: Examining Diabetes Treatment Disparities

February 08, 2021

According to a recent JAMA Network Open study, Medicare Advantage (MA) enrollees with diabetes are less likely to be treated with newer glucose-lowering medications compared to beneficiaries enrolled in commercial insurance plans.

Rozalina G McCoy, MD, MS, Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, and colleagues compared the initiation of treatment with newer medications to lower glucose levels between 382,574 adults, aged between 58 to 66 years with type 2 diabetes insured by MA (n=172,180) and those insured by commercial health plans (210,394) from 2016 to 2019.

“The odds of initiating GLP-1RA, SGLT2i, and DPP-4i treatment were examined for MA vs commercial insurance beneficiaries using 3 separate logistic regression models adjusted for year and demographic and clinical factors,” explained Dr McCoy and colleagues. “These models were used to calculate adjusted annual rates of medication initiation by health plan.”

According to results of the study:

  • adjusted rates of initiation of GLP-1RA, SGLT2i, and DPP-4i treatment increased among all beneficiaries, from 2.14% to 20.02% for GLP-1RA among commercial insurance beneficiaries and from 1.50% to 11.44% among MA beneficiaries;
  • from 2.74% to 18.15% for SGLT2i among commercial insurance beneficiaries and from 1.57% to 8.51% among MA beneficiaries;
  • and from 3.30% to 11.71% for DPP-4i among commercial insurance beneficiaries and from 2.44% to 7.68% among MA beneficiaries.

Data showed that initiation rates for all 3 drug classes were consistently lower for MA beneficiaries year over year.  

In terms of income-related disparities, the odds of starting GLP-1RA and SGLT2i increased with income. For patients with an income of $200 000 and higher vs less than $40 000, the odds ratio for GLP-1RA was 1.23 (95% CI, 1.15-1.32) and for SGLT2i was 1.16 (95% CI, 1.09-1.24). The researchers note that this trend could potentially be contributing to poor health outcomes in this population.

Overall, Dr McCoy and colleagues explained that these findings imply that more innovative solutions are needed to address logistical and financial barriers to evidence-based diabetes management, including simplifying coverage requirements, reducing cost-sharing responsibilities, and creating transparent and straightforward avenues for all patients to obtain and afford the medications they need to optimally manage their disease.

“Better understanding of nonclinical factors contributing to treatment decisions and efforts to promote greater equity in diabetes management appear to be needed,” concluded the authors of the studies.

—Edan Stanley


McCoy RG, Van Houten HK, Deng Y, et al. Comparison of diabetes medications used by adults with commercial insurance vs Medicare advantage, 2016 to 2019. JAMA Netw Open. 2021;4(2):e2035792. doi:10.1001/jamanetworkopen.2020.35792

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