Costs of Diabetes Drug Prescription Claims Plunge After Metabolic Surgery

Health insurance providers saved big on prescription diabetes medications after patients underwent metabolic surgery, according to claims-based registry data from Michigan.

Among 760 patients with type 2 diabetes who underwent metabolic surgery, the mean decrease in diabetes prescription payments made by the insurer was $4,133 per patient — $6,736 for gastric bypass and $3,409 for sleeve gastrectomy — in the 360 days after surgery compared with the 360 days before surgery, reported Oliver A. Varban, MD, of Henry Ford Health in Detroit, and colleagues.

Also at 360 days after surgery, 67.7% of patients with follow-up were not filling any prescriptions for any type of diabetes medication, they noted in a research letter published in JAMA Surgery.

“Given that 34% of all patients undergoing metabolic surgery in Michigan have diabetes and a total of 54,454 metabolic procedures were performed between 2015 and 2021, it is estimated that insurance providers in Michigan saved more than $76.5 million on diabetes medications in the 360 days following surgery,” Varban and team wrote.

Of note, most savings occurred within the first 120 days after surgery, they said.

“We found a considerable cost savings resulting from discontinuation of medications for diabetes after metabolic surgery, which only represented prescription activity for 1 year following metabolic surgery and did not account for potential cumulative savings as a result of long-term diabetes remission or downstream cost benefits associated with optimizing diabetes management,” the group noted.

For this study, Varban and co-authors used the Michigan Value Collaborative claims data registry, a consortium of more than 100 nonfederal acute care hospitals in Michigan, and included 760 patients undergoing gastric bypass (22%) or sleeve gastrectomy (78%) from 2015 to 2021.

Mean patient age was 49, and 66.3% were women. About 84% of patients had hypertension, 73.4% had hyperlipidemia, and 60.8% had obstructive sleep apnea.

In the 120 days prior to surgery, 88% of patients had filled an outpatient oral diabetes medication prescription, 30% filled an insulin prescription, and 21% filled a GLP-1 receptor agonist prescription. More than half of patients were only on an oral agent prior to surgery, and another third were on multimodal therapy.

The price-standardized 30-day payment for surgery was $14,832.

Varban and colleagues noted that their study only included patients with Blue Cross Blue Shield Preferred Provider Organization commercial insurance or Medicare Advantage membership who were continuously enrolled in a prescription plan for 120 days prior to surgery and at least 240 days after surgery, and their findings don’t necessarily reflect those with other insurance plans.

“Given that fewer than 1% of the eligible population undergo surgical treatment for obesity and metabolic disease in the U.S. and only one-fourth of patients undergoing surgery are diagnosed with diabetes, we believe that there is an opportunity to decrease the financial and medical burden of diabetes,” they concluded.