Are Statins an Answer to Lowering Diabetes Care Costs?

Statins, often prescribed by doctors to help lower cholesterol levels in the blood, may help people with diabetes avoid complications like heart disease and stroke.

Stroke and heart disease are common complications for people living with diabetes, and the conditions drive up the cost of care. However, a simple — and cheap — preventive measure can lower the risk of such complications, according to two studies from national pharmacy benefits manager Prime Therapeutics.

People with diabetes had 2.5 times higher medical and pharmaceutical spending compared to people without diabetes, Prime researchers found after comparing medical and pharmacy claims of members with and without diabetes from 2014 to 2015.

The per member, per year total cost of care for members with diabetes was $15,771, while matched members without diabetes had an average per member, per year cost of $6,385.

Of the $9,386 in excess cost for people with diabetes, 35.2 percent was attributed to prescription drug claims and 64.8 percent was medical care.

Atherosclerotic cardiovascular disease and associated conditions drove the bulk of the excess medical costs, accounting for 15.5 percent, while diabetes (14.1 percent) and chronic kidney disease (13.7 percent) came in close behind.

An ounce of prevention

Fortunately, a simple preventive step — taking statins — can help members with diabetes avoid complications like heart problems or a stroke. In fact, the American College of Cardiology (ACC) and the American Heart Association (AHA) issued recommendations in 2013 saying most people age 40 to 75 with diabetes should receive statins as a preventive measure.

Statins are a class of drugs often prescribed by doctors to help lower cholesterol levels in the blood. By lowering the levels, they help prevent heart attacks and stroke.

Prime researchers found members with diabetes who adhered to proper statin therapy had a 23 percent lower rate of experiencing a cardiovascular event than members with diabetes who did not take statins.

“Statins cost just pennies a day, compared to the significant cost of treating a heart attack or stroke,” says Dr. Kevin Bowen, a principal health outcomes researcher with Prime.

Unfortunately, many members with diabetes do not have a prescribed statin regimen, despite the recommendations from the ACC and AHA.

Looking at 2014 data for 250,000 members age 40 to 64 with diabetes, Prime researchers discovered just 54.7 percent had a claim for a statin. Of those, only 26.9 percent were adherent in taking the statin as prescribed.

Bowen calls this fact “alarming” and that access to statins is extremely important for members with diabetes.

The numbers may improve in response to a recommendation in late 2016 by the U.S. Preventive Services Task Force. The influential panel of experts backed the use of statins to prevent cardiovascular disease in adults ages 40 to 75 if they have one or more risk factors for cardiovascular disease — such as diabetes — and a 10-year risk of 10 percent or higher for experiencing a cardiovascular event.

Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas will begin covering select prescription statins with no out-of-pocket costs for most members beginning Dec. 1, 2017. The Plans, as well as several independent Blue Cross and Blue Shield Plans, have an ownership interest in Prime and contract with the company for pharmacy benefit management and other related services.

“Helping people with diabetes access appropriate statin therapy and stay on them can improve their health and better manage the increasing cost of treating diabetes,” Bowen says.


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