OBJECTIVE To examine the association between preventive drug lists (PDLs) and changes in medication costs among patients with diabetes insured in commercial health plans over 2 follow-up years. RESEARCH DESIGN AND METHODS We conducted a quasiexperimental study using the Optum deidentified Clinformatics Data Mart Database (January 2003 to December 2017). The intervention group included 5,582 patients with diabetes age 12–64 years switched by employers to PDL coverage; the control group included 5,582 matched patients whose employers offered no PDL. Outcomes included out-of-pocket costs, standardized costs, and 30-day fills for all medications because PDL-associated savings could be used to pay for medicines in other classes and for five therapeutic classes covered by the PDLs (oral diabetic medications, insulins, test strips, antihypertensive drugs, and lipid-lowering drugs). RESULTS Pre– to post–out-of-pocket spending for all medications declined by 29.7% in follow-up year 2 (95% CI −36.0, −23.4%) among PDL members relative to controls. Higher-income and lower-income PDL members experienced significant reductions in out-of-pocket spending for all medications in year 2 (30%) and for key therapeutic classes (range −23 to −67%). We found significant increases in use of key therapeutic classes in the overall population (range 8–15%) and in higher-income and lower-income PDL members (range 9–50%). CONCLUSIONS PDLs offer an effective strategy for employers and insurers to lower member cost sharing and encourage increased use of important medications to prevent or manage chronic illnesses. For patients with diabetes, especially those with lower incomes, PDL coverage resulted in substantial and persistent reductions in out-of-pocket medication costs, medication use increases, and some increased use of more expensive products.

中文翻译：

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采用预防性药物清单对 2 年内药物成本和收入差异的影响：糖尿病翻译的自然实验 （NEXT-D） 研究


目的 探讨预防药物清单 （PDL） 与 2 年随访期间商业健康计划投保糖尿病患者用药费用变化之间的关联。研究设计和方法 我们使用 Optum 去标识化 Clinformatics Data Mart 数据库（2003 年 1 月至 2017 年 12 月）进行了一项准实验研究。干预组包括 5,582 名年龄在 12-64 岁之间的糖尿病患者，这些患者被雇主转为 PDL 保险;对照组包括 5,582 名匹配的患者，他们的雇主不提供 PDL。结局包括自付费用、标准化成本和所有药物的 30 天填充，因为 PDL 相关的储蓄可用于支付其他类别的药物和 PDL 涵盖的五个治疗类别（口服糖尿病药物、胰岛素、试纸、抗高血压药物和降脂药物）。结果 与对照组相比，PDL 成员在随访第 2 年的所有药物的前后自付费用下降了 29.7% （95% CI -36.0， -23.4%）。高收入和低收入 PDL 成员在第 2 年 （30%） 和关键治疗类别（范围 -23 至 -67%）的自付费用显着减少。我们发现，在总人群（范围 8-15%）以及高收入和低收入 PDL 成员（范围 9-50%）中，关键治疗类别的使用显着增加。结论 PDL 为雇主和保险公司提供了一种有效的策略，以降低会员成本分摊并鼓励增加使用重要药物来预防或管理慢性病。 对于糖尿病患者，尤其是低收入患者，PDL 覆盖率导致自付费用药费用大幅且持续减少，药物使用量增加，并增加了对更昂贵产品的使用。