Abarca Health: New CMS Basal Insulin measure

Diabetes affects more than 37 million U.S. adults and is the seventh leading cause of death in the country. Of that group, approximately 7.4 million rely on insulin to manage their condition. To help address this, the Centers for Medicare and Medicaid Services (CMS) released a new display measure in April, called Persistence to Basal Insulin (PST-INS). This measure helps to evaluate the percentage of Medicare Part D beneficiaries that are treatment persistent or stay on their treatment, to basal insulin by tracking pharmacy claims.

Basal insulin (sometimes referred to as background insulin because it works when the patient is not eating) helps diabetes patients maintain stable blood glucose levels throughout the day. There are three types of basal insulin (intermediate-acting, long-acting, and ultra-long acting), which all last in the body for different periods of time. Some basal insulin drugs you might have heard of, such as Tresiba (insulin degludec), Levemir (insulin detemir), and Lanus (insulin glargine), are included in the new measure.

When it comes to basal insulin, persistence has been linked to a variety of positive outcomes, including fewer visits to the emergency room and lower healthcare costs compared to those who stopped treatment.

Many factors come into play that impacts whether someone takes their prescription, including experiencing unpleasant side effects, drug costs, or simply forgetting. But when it comes to this new CMS measure, it is important to understand the difference between being “treatment persistent” and “treatment adherent.”

Persistence vs. Adherence
Persistence, which the new CMS measure uses, is more rigid – as soon as a single gap in adherence is identified, a patient is no longer persistent. Here are a few key differences:

  • Being persistent requires all refills on or before the expected refill date. Whereas, adherence requires a percentage of covered days or possession ratio.
  • Adherence requires at least two fills to measure a potential gap in adherence. Whereas persistence only requires a single fill.
  • A patient can be adherent without being persistent

Who is included in this metric?
While the new metric shows the percentage of Medicare Part D beneficiaries persistent to basal insulin, it doesn’t include people under the age of 18, anyone receiving hospice care, or those diagnosed with gestational diabetes or end-stage renal disease.

What does this mean for plans?
Diabetes is the most expensive chronic condition in the US. By ensuring members are persistent to basal insulin, health plans can reduce the risk of adverse health events and other related costs. And while this metric is not yet included in STARS measures, it may be added in the future.

What does the industry say?
Research has shown the importance of basal insulin persistence and this CMS measure will make it easier for individuals and providers to find persistence rates. Organizations like the Pharmacy Quality Alliance have welcomed and enthusiastically endorsed the new measure.

At Abarca, we believe this measure is a critical step in improving member health. But, for it to make a real impact, it is up to PBMs to ensure that they–and their partners–have the technology and resources necessary to support it.

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*This blog was written by Ana M. Rivera, PharmD., Associate Director of Clinical Services at Abarca Health.

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