Study: Preventive Diabetes Care Can Improve Patient Outcomes

Two new studies conducted by pharmacy benefit manager Prime Therapeutics found that members with diabetes had 2.5 times higher medical and pharmacy spending than their contemporaries without diabetes. However, the authors found that members taking statins to prevent heart disease reduced their risk of experiencing a cardiovascular event by more than 23%, according to a press release.

These latest findings will be presented at the Academy of Managed Care Pharmacy’s 2017 Annual Meeting.

The first study included commercially insured Prime member medical and pharmacy claims from 2014 to 2015. Included in the study were 5.5 million patients, with 5.1% diagnosed with diabetes.

The authors found that the mean per member per year (PMPY) cost for patients with diabetes was $15,771, which was 2.5 times higher than the $6385 PMPY cost for matched patients without diabetes, according to the study.

Of the excess $9386 PMPY cost of care for patients with diabetes, 64.8% was attributed to medical care and 35.2% was for prescription drugs. Medical costs were associated with atherosclerotic cardiovascular disease and related conditions, diabetes, and chronic kidney disease. Among these pharmacy claims, diabetes drugs and supplies accounted for 72.2% of costs, according to the release.

“Diabetes accounts for $1 of every $10 in pharmacy benefit expense and there is additional expense for individuals with diabetes administered on the medical benefit,” said Kevin Bowen, MD, MBA, principal health outcomes researcher at Prime. “Prime best serves the needs of our health plan clients by fully understanding total diabetes costs — on both medical and pharmacy benefits. This allows us to focus interventions where they are most useful.”

The second study demonstrated the ability to improve care for patients with diabetes and manage costs through preventive treatment, according to Prime. Current American College of Cardiology (ACC) and American Heart Association (AHA) guidelines suggest that patients with diabetes receive treatment with statins to prevent heart disease, but real-world data have not been able to show the benefit of the drugs.

Included in the study were 250,000 Prime members from 2014 to 2015 who were younger than 65 and had a claim for a diabetes treatment other than metformin, or who had 1 inpatient or 2 outpatient medical claims services with a diabetes code, according to the release.

The study authors discovered that patients who were adherent to statin therapy were 23% less likely to experience a cardiovascular event, compared with those not taking the drug or were non-adherent to the treatment.

In 2014, only 54.7% of study participants had a pharmacy claim for statins. However, 26.9% of members were adherent to therapy, while 27.7% were not taking or were not adherent to the drug, according to the study.

In 2015, 1.24% of patients who were adherent to statin therapy in 2014 experienced a cardiovascular event, compared with 1.61% of non-adherent patients. The authors reported that statin adherent patients were 23.4% less likely to experience cardiovascular events.

To improve statin adherence among members, Prime’s GuidedHealth program contacts providers who have prescribed a diabetes drug to certain patients. The provider is asked to evaluate the patient’s history to determine if a statin would be an appropriate addition to their medication regimen to better control disease and lower costs, according to the release.

“The ACC/AHA guidelines recommend primary prevention for nearly all persons with diabetes who are age 40 to 75. It’s alarming that only half of these members were taking a statin a year after the ACC/AHA guidelines were released recommending them, and far fewer were taking their medication as prescribed,” Bowen concluded. “Statins cost just pennies a day, compared to the significant cost of treating a heart attack or stroke. Helping people with diabetes access appropriate statin therapy and stay on them can improve their health and better manage the increasing cost of treating diabetes.”