@article{14f0451fca224e9098045ba895c3687d,
title = "Medicaid expansion and utilization of antihyperglycemic therapies",
abstract = "OBJECTIVE Certain antihyperglycemic therapies modify cardiovascular and kidney outcomes among patients with type 2 diabetes, but early uptake in practice appears restricted to particular demographics. We examine the association of Medicaid expansion with use of and expenditures related to antihyperglycemic therapies among Medicaid beneficiaries. RESEARCH DESIGN AND METHODS We employed a difference-in-difference design to analyze the association of Medicaid expansion on prescription of noninsulin antihyperglycemic therapies. We used 2012–2017 national and state Medicaid data to compare prescription claims and costs between states that did (n = 25) and did not expand (n = 26) Medicaid by January 2014. RESULTS Following Medicaid expansion in 2014, average noninsulin antihyperglycemic therapies per state/1,000 enrollees increased by 4.2%/quarter in expansion states and 1.6%/quarter in nonexpansion states. For sodium–glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA), quarterly growth rates per 1,000 enrollees were 125.3% and 20.7% for expansion states and 87.6% and 16.0% for nonexpansion states, respectively. Expansion states had faster utilization of SGLT2i and GLP-1RA than nonexpansion states. Difference-in-difference estimates for change in volume of prescriptions after Medicaid expansion between expansion versus nonexpansion states was 1.68 (95% CI 1.09–2.26; P < 0.001) for all noninsulin therapies, 0.125 (-0.003 to 0.25; P = 0.056) for SGLT2i, and 0.12 (0.055–0.18; P < 0.001) for GLP-1RA. CONCLUSIONS Use of noninsulin antihyperglycemic therapies, including SGLT2i and GLP-1RA, increased among low-income adults in both Medicaid expansion and nonexpansion states, with a significantly greater increase in overall use and in GLP-1RA use in expansion states. Future evaluation of the population-level health impact of expanded access to these therapies is needed.",
author = "Andrew Sumarsono and Buckley, {Leo F.} and Machado, {Sara R.} and Wadhera, {Rishi K.} and Warraich, {Haider J.} and Desai, {Rishi J.} and Everett, {Brendan M.} and McGuire, {Darren K.} and Fonarow, {Gregg C.} and Javed Butler and Ambarish Pandey and Muthiah Vaduganathan",
note = "Funding Information: Funding. R.K.W. receives research support from the National Heart, Lung, and Blood Institute (K23HL148525-1). G.C.F. receives research funding from the National Institutes of Health (NIH). J.B. has received research support from the NIH, Patient-Centered Outcomes Research Institute, and the European Union. A.P. is supported by the Texas Health Resources Clinical Scholars Program. M.V. is supported by the KL2/Catalyst Medical Research Investigator Training award from Harvard Catalyst (NIH/National Center for Advancing Translational Sciences award UL 1TR002541). Duality of Interest. L.F.B. reports research support from Akcea Therapeutics LLC. R.K.W. served as a consultant for Regeneron. R.J.D. has served as principal investigator on research grants from Novartis, Bayer, and Vertex to the Brigham and Women{\textquoteright}s Hospital. B.M.E. reports receiving grant support and/or consulting for Amgen, Amarin, Gilead, Merck, Novartis, and Roche Diagnostics. D.K.M. reports honoraria for trial leadership from AstraZeneca,Sanofi,Janssen,BoehringerIngelheim, Merck & Co., Pfizer, Novo Nordisk, Lexicon, Eisai, GlaxoSmithKline, Esperion, and Lilly US, and honoraria for consulting for AstraZeneca, Sanofi, Lilly US, AstraZeneca, Boehringer Ingelheim, Merck & Co., Pfizer, Novo Nordisk, Metavant, Applied Therapeutics, and Affimune. G.C.F. serves as a consultant for Abbott, Amgen, AstraZeneca, Bayer,CHFSolutions,Janssen,Medtronic,Merck, and Novartis. J.B. serves as a consultant for Amgen, Array, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, CVRx, G3 Pharmaceutical, Innolife, Janssen, Luitpold, Medtronic, Merck, Novartis, Relypsa, StealthPeptide, SC Pharma, Vifor, and ZS Pharma. M.V. serves on advisory boards for Amgen, AstraZeneca, Baxter Healthcare, Bayer AG, Boehringer Ingelheim, Cy-tokinetics, and Relypsa, and participates on clinical endpoint committees for studies sponsored by Galmed, Novartis, and the NIH. No other potential conflicts of interest relevant to this article were reported. Author Contributions. A.S., L.F.B., S.R.M., and M.V. designed the study, conducted the data analyses, and drafted the manuscript. All authors participated in critical review and revisions of the manuscript. A.S. and M.V. are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Prior Presentation. Parts of this study were presented as a late-breaking poster at the 80th Scientific Sessions of the American Diabetes Association, 12–16 June 2020. Funding Information: R.K.W. receives research support from the National Heart, Lung, and Blood Institute (K23HL148525-1). G.C.F. receives research funding from the National Institutes of Health (NIH). J.B. has received research support from the NIH, Patient-Centered Outcomes Research Institute, and the European Union. A.P. is supported by the Texas Health Resources Clinical Scholars Pro-gram. M.V. is supported by the KL2/Catalyst Medical Research Investigator Training award from Harvard Catalyst (NIH/National Center for Advancing Translational Sciences award UL 1TR002541). Publisher Copyright: {\textcopyright} 2020 by the American Diabetes Association.",
year = "2020",
month = nov,
doi = "10.2337/dc20-0735",
language = "English (US)",
volume = "43",
pages = "2684--2690",
journal = "Diabetes care",
issn = "0149-5992",
publisher = "American Diabetes Association Inc.",
number = "11",
}