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期刊来源：Ann Intern Med

原文链接：https://doi.org/10.7326/M23-1965

摘要内容如下：

背景

25个州已经实施了胰岛素自付（OOP）成本上限，但其有效性尚不确定。

客观

在商业保险的糖尿病患者中，研究国家胰岛素OOP上限对胰岛素使用和OOP费用的影响。

设计

与对照组的前后研究。

设置

8个州在2021年1月实施25美元至30美元、50美元或100美元的胰岛素OOP上限，以及17个对照州。

参与者

65岁以下的商业保险糖尿病患者和胰岛素使用者。特别感兴趣的分组包括来自胰岛素OOP上限为25美元至30美元的州的成员、需要支付高额胰岛素OOP的健康储蓄账户（HSA）的注册者以及低收入成员。

测量

平均每月30天胰岛素用量和OOP成本。

结果

在总体人群中，胰岛素用量与胰岛素使用的变化无关（每月用量的相对变化为1.8%[95%CI为-3.2%~6.9%]）。干预州的胰岛素使用者的胰岛素OOP成本相对降低了17.4%（CI，-23.9%至-10.9%），这主要是由于HSA注册者的减少；非帐户计划成员之间的OOP成本没有差异。更慷慨（$25至$30）的州胰岛素OOP上限与40.0%（CI，-62.5%至-17.6%）的胰岛素OOP成本降低相关，同样主要是由HSA计划的亚组的更大降低所驱动。

局限性

单一国家保险人；随访9个月。

结论

胰岛素OOP CAPS与胰岛素OOP成本降低有关，但总体上没有增加胰岛素的使用。为商业被保险人提议的35美元的国家胰岛素上限可能会带来有意义的胰岛素OOP节省，但对胰岛素使用的影响有限。

主要资金来源

疾病控制和预防中心以及国家糖尿病、消化和肾脏疾病研究所。

英文原文如下：

Abstracts

BACKGROUND  Twenty-five states have implemented insulin out-of-pocket (OOP) cost caps, but their effectiveness is uncertain.

OBJECTIVE  To examine the effect of state insulin OOP caps on insulin use and OOP costs among commercially insured persons with diabetes.

DESIGN  Pre-post study with control group.

SETTING  Eight states implementing insulin OOP caps of $25 to $30, $50, or $100 in January 2021, and 17 control states.

PARTICIPANTS  Commercially insured persons with diabetes and insulin users younger than 65 years. Subgroups of particular interest included members from states with insulin OOP caps of $25 to $30, enrollees with health savings accounts (HSAs) that require high insulin OOP payments, and lower-income members.

MEASUREMENTS  Mean monthly 30-day insulin fills and OOP costs.

RESULTS  State insulin caps were not associated with changes in insulin use in the overall population (relative change in fills per month, 1.8% [95% CI, -3.2% to 6.9%]). Insulin users in intervention states saw a 17.4% (CI, -23.9% to -10.9%) relative reduction in insulin OOP costs, largely driven by reductions among HSA enrollees; there was no difference in OOP costs among nonaccount plan members. More generous ($25 to $30) state insulin OOP caps were associated with insulin OOP cost reductions of 40.0% (CI, -62.5% to -17.6%), again primarily driven by a larger reduction in the subgroup with HSA plans.

LIMITATIONS  Single national insurer; 9-month follow-up.

CONCLUSION  Insulin OOP caps were associated with reduced insulin OOP costs but no overall increases in insulin use. A proposed national insulin cap of $35 for commercially insured persons might lead to meaningful insulin OOP savings but have a limited effect on insulin use.

PRIMARY FUNDING SOURCE  Centers for Disease Control and Prevention and National Institute of Diabetes and Digestive and Kidney Diseases.

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