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Patients with diabetes on Medicare Advantage less likely to receive new drugs

Although patients with diabetes on Medicare Advantage plans are more likely to receive preventative treatments, they are less likely to be prescribed newer, more expensive medications, and are more likely to have higher blood pressure and poorer blood pressure control. blood glucose than Medicare-charged patients. Service plans, according to a new study led by a physician-scientist at the University of Pittsburgh School of Medicine.

The study, published today in Diabetes Care, raises a red flag that, while improving access to preventive care, the rapid growth of Medicare Advantage enrollments may portend a trend toward poorer health outcomes and disparities in care compared to your Medicare rate. Service equivalents.

“Preventive treatments are not enough to prevent patients from using the healthcare system in the future,” said lead author Utibe Essien, MD, MPH, adjunct professor of medicine at the University of Pittsburgh and VA Pittsburgh staff physician Healthcare System. “We need to make sure that the right patients receive the right treatment, probably a combination of preventive and therapeutic interventions.”

Diabetes is reported in 1 in 5 Medicare beneficiaries age 65 and older and is associated with more than 60% more out-of-pocket prescription costs compared to those without diabetes.

The researchers used data from more than 5,000 physicians participating in The Diabetes Collaborative Registry to study nearly 350,000 patients with type 2 diabetes aged 65 or older with Medicare Advantage or Medicare Fee-For-Service plans. They compared quality metrics, preventive care, and prescription patterns between the two groups.

The study found that patients with Medicare Advantage were more likely to receive preventative treatments, such as smoking cessation, foot care, and other controls. However, patients on Medicare Advantage plans were also more likely to have higher blood pressure and poorer diabetes control, and were less likely to receive newer evidence-based medications than their counterparts by service rate plans. of Medicare. Medicare Advantage uses a variety of strategies to mitigate the cost of care, including limiting access to newer, more expensive drugs.

Old generic medications for diabetes, such as angiotensin converting enzyme inhibitors (ACEs) and angiotensin receptor blockers (ARAs), were appropriately prescribed to Medicare Advantage beneficiaries. But when it comes to newer, more expensive drugs, such as glucagon-like peptide-1 receptor agonists (GLP-1RA) or sodium / glucose-2 cotransporter inhibitors (SGLT2i), Essien said, ” “We saw a clear drop in Medicare Advantage. Enrollees receive these drugs, despite the unequivocal evidence that they benefit patients with diabetes by reducing kidney disease, cardiovascular disease and death.”

“With Medicare Advantage plans continuing to expand rapidly and now covering nearly half of all Medicare beneficiaries, these data call for continued monitoring of long-term health outcomes under various Medicare plans,” he said. main author Muthiah Vaduganathan, MD, MPH, co-director. from the Center for Implementation Science and staff cardiologist at Brigham and Women’s Hospital and Harvard Medical School.

Researchers hope these findings can help fine-tune the Medicare Advantage program, allowing patients to access the care and treatments they need, while keeping healthcare costs and utilization low.

“Given the increasing risk factors for diabetes among Americans, we will see an increasing number of Medicare Advantage enrollees in need of high-quality diabetes care,” Essien said. “I’m a general internist. My main focus is prevention, but our data suggests it’s not enough.”

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