Medicare Advantage Beneficiaries Less Likely to Receive Newer Diabetes Medications

Utibe Essien, MD, MPH

Medicare Advantage patients with diabetes are more likely to receive preventive treatments, but less likely to be prescribed newer medications, more likely to have higher blood pressure, and worse glycemic control than patients on Medicare Fee-For-Service plans, according to new research from the University of Pittsburgh School of Medicine.

A retrospective study of Medicare beneficiaries enrolled in the Diabetes Collaborative Registry from 2014-2019, results demonstrate that, while they were more likely to receive ACE inhibitors or ARBs, Medicare Advantage beneficiaries were 20% less likely to receive GLP-1 RAs and 9% less likely to receive SGLT2 inhibitors in adjusted analyses compared to their counterparts in fee-for-service (FFS) Medicare programs.

“Preventive treatments are not enough to keep patients from utilizing the health care system down the road,” said lead author Utibe Essien, MD, MPH, assistant professor of medicine at the University of Pittsburgh and staff physician at the VA Pittsburgh Healthcare System, in a statement. “We need to make sure the right patients are getting the right treatment, likely a combination of preventive and therapeutic interventions.”

Now that an abundance of literature and data has outlined the previously unrecognized cardiorenal protective benefits of newer antidiabetic agents, the focus among the medical community has begun to shift away from uncovering additional benefits from use to optimizing uptake of these agents. An outpatient US-based quality improvement registry encompassing more than 5000 clinicians from 374 interdisciplinary practices, the Diabetes Collaborative Registry provided instigators with data related to more than 300,000 Medicare beneficiaries with a diagnosis of type 2 diabetes. Of the 345,911 individuals deemed eligible for inclusion in the investigators’ analyses, 229,598 were enrolled in FFS plans and 116,313 were enrolled in Medicare Advantage plans, with all individuals deemed eligible having completed at least 1 or more months of enrollment.

For the purpose of analyses, investigators identified 3 sets of outcomes related to diabetes care: quality of care metrics, intermediate health outcomes, and antihyperglycemic prescription patterns. These were assessed using multivariable hierarchical logistic regression models, with patient characteristics as fixed effects and practice sites as a random effect.

Investigators pointed out Medicare Advantage and FFS beneficiaries had similar ages (74.6±6.7 vs. 74.7±7.0 years) and proportions of women (50.4% vs. 46.1%). However, Medicare Advantage enrollees were less likely to be white (80.5% vs. 87.8%), more likely to be dually eligible for Medicare and Medicaid (20.4% vs. 11.9%), and lived in areas of lower median income level ($52,700 vs. $56,200). Additionally, Medicare Advantage beneficiaries were less likely to be treated by a cardiologist (41.2% vs. 44.7%) or endocrinologist (7.1% vs. 9.8%) compared to those in FFS programs.

Upon analysis, results indicated Medicare Advantage beneficiaries were likely to receive ACE 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 to FFS beneficiaries. Further analysis demonstrated being a Medicare Advantage beneficiary was independently associated with a decrease in the likelihood of receiving GLP-1 RAs (6.9% vs. 9.0%; aOR, 0.80 [95% CI 0.77-0.84]) and SGLT2 inhibitors (5.4% vs. 6.7%; aOR, 0.91 [95% CI 0.87-0.95]). Additional analysis using linked data from the Centers for Medicare and Medicaid Services from 2014-2017 and data from the Diabetes Collaborative Registry through 2019, investigators found these trends in therapeutic differences persisted, including among those in subgroups defined by the presence of established cardiovascular disease and chronic kidney disease.

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

This study, “Diabetes Care Among Older Adults Enrolled in Medicare Advantage Versus Traditional Medicare Fee-For-Service Plans: The Diabetes Collaborative Registry,” was published in Diabetes Care.