140-OR: Projected Impact of the Medicare Part D Senior Savings Model (SSM) on Diabetes-Related Health and Economic Outcomes among Insulin Users Covered by Medicare

CMS announced the Medicare Part D SSM to lower out-of-pocket costs for insulin. This study aimed to estimate the impacts of the SSM on clinical and economic outcomes among Medicare insulin users. We used the 2015-2016 National Health and Nutrition Examination Survey to generate a nationally representative simulation sample. We used the Building, Relating, Validating, Assessing, Outcomes (BRAVO™) Diabetes microsimulation model to simulate the impact of the SSM on diabetes-related complications, quality-adjusted life-years (QALYs), and medical costs. We used 30% rebate rate for Medicare insulin payment. 1.29 million insulin users covered by Medicare enhanced health plans are projected to be eligible for SSM in 2021. The SSM associated risk reductions in complications were reported in the Table. Over 5 years, the SSM is projected to increase $2.0 billion medical cost ($1,573/person) with a gain of 7,750 (0.01/person) QALYs (Incremental cost-effectiveness ratio (ICER): $157,300/QALY). In 20 years, the SSM will incur an additional $4.5 billion medical cost ($3474/person) with an increased QALYs of 72,095 (0.06/person, ICER=$57,900/QALY). Because the SSM was projected to increase medical costs for diabetes, this policy would have to be in place for longer than the 5-year period (as currently planned), or further reduce Medicare payment on insulin. Disclosure H. Shao: Research Support; Self; Sanofi. H. Kianmehr: None. L. Shi: Research Support; Self; AstraZeneca, Sanofi. V. Fonseca: Consultant; Self; Abbott Diabetes, Asahi Kasei Corporation, Bayer Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Intarcia Therapeutics, Inc., Novo Nordisk, Pfizer Inc., Sanofi-Aventis, Stock/Shareholder; Self; Amgen Inc., Bravo4health, Mellitus Health. J. D. Brown: None.