Insulin Out‐of‐Pocket Spending Caps and Employer‐Sponsored Insurance: Changes in Out‐of‐Pocket and Total Costs for Insulin and Healthcare

作者：Khrysta Baig, Carrie Fry, Melinda Beeuwkes Buntin, Alvin C. Powers, Stacie B. Dusetzina · 发表于：Health Services Research · 年份：2025 · DOI：10.1111/1475-6773.14656 · 被引用次数：3 · 研究领域：Medication Adherence and Compliance、Diabetes Management and Research、Healthcare Policy and Management

OBJECTIVE: To estimate the impact of state-level insulin out-of-pocket caps on changes in out-of-pocket and total costs of insulin and healthcare for insulin users with employer-sponsored insurance. STUDY SETTING AND DESIGN: We evaluated changes in costs using a quasi-experimental (triple difference-in-differences; "DDD") design to analyze multi-carrier claims from insulin users enrolled in fully insured (state-regulated) and self-funded (generally exempt) employer-sponsored plans in 10 states with caps by January 2021 compared to no-cap states pre-/post-cap implementation. Primary outcomes were changes in insulin out-of-pocket spending, total (plan + member) paid for insulin, and total healthcare costs. Secondary outcomes were intermediary (e.g., pharmaceutical) changes in out-of-pocket and total costs. DATA SOURCES AND ANALYTIC SAMPLE: In the policy year (no-cap states: 2021), we identified 218,441 insulin-users in the Health Care Cost Institute 2.0 Dataset (cap states: 27,834 in fully insured and 22,131 in self-funded plans; no-cap states: 97,239 in fully insured and 71,237 in self-funded plans) and 215,635 in the year prior. PRINCIPAL FINDINGS: We found evidence of modest decreases in 30-day standardized (DDD: -$5 [95% CI: -$6 to -$4]; p < 0.001) and annual (DDD: -$67 [95% CI: -$82 to -$51]; p < 0.001) insulin out-of-pocket spending. Savings increased by spending quantile (e.g., 95th-percentile change:-$347 [95% CI: -$460 to $233]). Difference-in-differences (DiD) compari...