Medicaid Eligibility Expansions May Address Gaps In Access To Diabetes Medications

Abstract

Diabetes is a top contributor to the avoidable burden of disease. Costly diabetes medications, including insulin and drugs from newer medication classes, can be inaccessible to people who lack insurance coverage. In 2014 and 2015 twenty-nine states and the District of Columbia expanded eligibility for Medicaid among low-income adults. To examine the impacts of Medicaid expansion on access to diabetes medications, we analyzed data on over ninety-six million prescription fills using Medicaid insurance in the period January 2008-December 2015. Medicaid eligibility expansions were associated with thirty additional Medicaid diabetes prescriptions filled per 1,000 population in 2014-15, relative to states that did not expand Medicaid eligibility. Age groups with higher prevalence of diabetes exhibited larger increases. The increase in prescription fills grew significantly over time. Overall, fills for insulin and for newer medications increased by 40 percent and 39 percent, respectively. Our findings suggest that Medicaid eligibility expansions may address gaps in access to diabetes medications, with increasing effects over time.

Keywords: Affordable Care Act; Chronic Care; Diabetes; Medicaid; Pharmaceuticals.

EXHIBIT 2

Diabetes prescription fills using Medicaid insurance per 1,000 population ages 20–64, in states that did and did not expand eligibility for Medicaid SOURCE Authors’ analysis of data from IQVIA. NOTE Most of the states that expanded Medicaid eligibility among low-income, nondisabled adults in 2014 or 2015 did so in the first quarter of 2014.

EXHIBIT 4

Prevalence of diabetes in 2013–14 and increase in Medicaid diabetes prescription fills per 1,000 population in 2014–15 associated with Medicaid eligibility expansions, by age group (years) SOURCE Authors’ analysis of data from IQVIA and the National Health and Nutrition Examination Survey. NOTE 2013–14 are the years just before and during Medicaid eligibility expansions, for most of the twenty-nine states (and the District of Columbia) that had expanded eligibility for Medicaid by the end of our sample period.