OBJECTIVE The Medicare Part D Senior Savings Model (SSM) took effect on 1 January 2021. In this study we estimated the number of beneficiaries who would benefit from SSM and the long-term health and economic consequences of implementing this new policy. RESEARCH DESIGN AND METHODS Data for Medicare beneficiaries with diabetes treated with insulin were extracted from the 2018 Medical Expenditure Panel Survey. A validated diabetes microsimulation model estimated health and economic impacts of the new policy for the 5-year initial implementation period and a 20-year extended policy horizon. Costs were estimated from a health system perspective. RESULTS Of 4.2 million eligible Medicare beneficiaries, 1.6 million (38.3%) would benefit from the policy, and out-of-pocket (OOP) costs per year per beneficiary would decrease by 61% or $500 on average. Compared with non-White subgroups, the White population subgroups would have a higher proportion of SSM enrollees (29.6% vs. 43.7%) and a higher annual OOP cost reduction (reduction of $424 vs. $531). Among the SSM enrollees, one-third (605,125) were predicted to have improved insulin adherence due to lower cost sharing and improved health outcomes. In 5 years, the SSM would 1) avert 2,014 strokes, 935 heart attacks, 315 heart failure cases, and 344 end-stage renal disease cases; 2) gain 3,220 life-years and 3,381 quality-adjusted life-years (QALY); and 3) increase insulin cost and total medical cost by $3.5 billion and $2.8 billion. In 20 years, the number of avoided clinical outcomes, number of life-years and QALY gained, and the total and insulin cost would be larger. CONCLUSIONS The Medicare SSM may reduce the OOP costs for approximately one-third of the Medicare beneficiaries treated with insulin, improving health outcomes via increased insulin adherence. However, the SSM will also increase overall Medicare spending for insulin and overall medical costs, which may impact future premiums and benefits. Our findings can inform policy makers about the potential impact of the new Medicare SSM.

中文翻译：

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医疗保险 D 部分高级储蓄模式 (SSM) 对医疗保险覆盖的胰岛素使用者与糖尿病相关的健康和经济成果的预计影响

目标 Medicare D 部分高级储蓄模式 (SSM) 于 2021 年 1 月 1 日生效。在这项研究中，我们估计了将从 SSM 中受益的受益人数量以及实施这项新政策的长期健康和经济后果。研究设计和方法 接受胰岛素治疗的糖尿病医疗保险受益人的数据取自 2018 年医疗支出小组调查。经过验证的糖尿病微观模拟模型估计了新政策对 5 年初始实施期和 20 年扩展政策期限的健康和经济影响。成本是从卫生系统的角度估算的。结果 在 420 万符合资格的 Medicare 受益人中，有 160 万 (38.3%) 人将从该保单中受益，每个受益人每年的自付费用 (OOP) 将减少 61%，即平均减少 500 美元。与非白人亚群体相比，白人亚群体的 SSM 登记者比例更高（29.6% vs. 43.7%），年度 OOP 成本降低幅度更高（减少 424 美元 vs. 531 美元）。在 SSM 参与者中，三分之一 (605,125) 预计由于成本分摊降低和健康结果改善而改善了胰岛素依从性。5 年内，SSM 将 1) 避免 2,014 例中风、935 例心脏病发作、315 例心力衰竭病例和 344 例终末期肾病病例；2) 获得 3,220 个生命年和 3,381 个质量调整生命年 (QALY)；3) 胰岛素成本和总医疗成本分别增加 35 亿美元和 28 亿美元。20年内，避免的临床结果的数量、获得的生命年数和QALY数以及总成本和胰岛素成本将会更大。结论 Medicare SSM 可以降低大约三分之一接受胰岛素治疗的 Medicare 受益人的 OOP 成本，通过增加胰岛素依从性来改善健康结果。然而，SSM 还将增加胰岛素的总体医疗保险支出和总体医疗费用，这可能会影响未来的保费和福利。我们的研究结果可以让政策制定者了解新的 Medicare SSM 的潜在影响。