Newer diabetes drugs prescribed less often for Medicare Advantage vs. traditional plans
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Despite having greater access to preventive care, Medicare Advantage beneficiaries had poorer intermediate health outcomes and were less likely to receive newer diabetes drug therapies compared with those with fee-for-service Medicare.
“Medicare Advantage plans often leverage incentive structures to maintain care quality while limiting excessive health care utilization. ... Since Medicare Advantage oversees total patient costs, these plans may also use various strategies to limit therapeutic expenditures and potentially introduce barriers to access to newer expensive therapies, including in diabetes management. On the other hand, Medicare Advantage plans may have longer-term incentives to use more expensive therapies if they can avoid more costly downstream care due to diabetes-related complications,” Utibe R. Essien, MD, MPH, an internal medicine physician and health equity researcher at the University of Pittsburgh School of Medicine, and colleagues wrote in background to study results published in Diabetes Care.
The researchers compared the diabetes care quality delivered under Medicare Advantage, Medicare’s managed care program, with traditional fee-for-service Medicare. The study included Medicare beneficiaries aged at least 65 years who were enrolled in the Diabetes Collaborative Registry from 2014 to 2019. Patients had type 2 diabetes and were treated with one or more diabetes medications.
Researchers compared quality measures, cardiometabolic risk factor control and diabetes drug prescription patterns between Medicare plan groups, adjusting for sociodemographic and clinical factors.
In all, the retrospective cohort study involved 345,911 Medicare beneficiaries, of whom 66% were enrolled in fee-for-service and 34% in Medicare Advantage plans for at least 1 month.
Medicare Advantage beneficiaries had a higher likelihood of receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers for coronary artery disease, tobacco cessation counseling, and screening for retinopathy, foot care and kidney disease (adjusted P .001 for all).
Compared with fee-for-service beneficiaries, Medicare Advantage beneficiaries had higher systolic blood pressure (+0.2 mm Hg), LDL cholesterol (+2.6 mg/dL) and HbA1c (+0.1%; adjusted P < .01 for all). In addition, Medicare Advantage patients were independently less likely to receive GLP-1 receptor agonists (6.9% vs. 9%; aOR = 0.8; 95% CI, 0.77-0.84) and SGLT2 inhibitors (5.4% vs. 6.7%; adjusted OR = 0.91; 95% CI, 0.87-0.95).
The researchers integrated CMS-linked data from 2014 to 2017 and more recent unlinked data from the Diabetes Collaborative Registry through 2019 (n = 411,465) and noted that these therapeutic differences remained, including those among subgroups with established cardiovascular and kidney disease.
“While Medicare Advantage plans enable greater access to preventive care, this may not translate to improved intermediate health outcomes,” the researchers concluded. “Medicare Advantage beneficiaries are also less likely to receive newer antihyperglycemic therapies with proven outcome benefits in high-risk individuals.”
They added that these findings reinforce the need for surveillance of long-term outcomes under various Medicare plan structures and for program evaluation to ensure that indicated but more costly care is not stinted among at-risk beneficiaries under managed care approaches. “Identifying strategies to ensure equitable access to high-quality diabetes care across population segments remains a high priority,” they wrote.
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