OBJECTIVES: Despite being covered by Medicare Part D and commercial insurance plans, adoption of SGLT-2 inhibitors has been slower among Black and female patients compared to their White and male counterparts. Additionally, Medicare beneficiaries tend to have lower usage rates compared to those with commercial insurance. This study aims to examine inequalities in SGLT-2 inhibitor use among Medicare patients with type 2 diabetes (T2D), based on demographic and socioeconomic factors and how these factors affect overall Medicare spending.

METHODS: This retrospective cohort study analyzed data from T2D patients with cardiovascular related diseases who received outpatient (hospital or physician office) care from January 2017 to August 2021 using the Medicare FFS Research Identifiable Files (RIFs). Index event was the date of first applicable diagnoses, and patients were followed for 12 months post-index (through August 2022). Multivariate linear and logistic regression were used to examine the association of demographic and socioeconomic factors on SGLT-2 use and Medicare spending. A regional-level random effect was also employed to control for geographic differences.

RESULTS: The study included 3,582,770 beneficiaries. 3.4% of Black T2D patients and 5.2% of White T2D patients were on an SGLT-2 inhibitor during the study period. In multivariable analyses, Black race (aOR=0.65, p<0.001), female (aOR=0.69, p<0.001), and people receiving low-income subsidy (aOR=0.92, p<0.001) were associated with lower rates of SGLT-2 inhibitor use. With a mean spending of $910, Black patients, on average, received $69 less in Medicare spending when compared to non-Black patients.

CONCLUSIONS: Despite the proven benefit of SGLT-2 inhibitors reducing hospitalizations and mortality, usage rates among Medicare patients with T2D and major cardiovascular outcomes, particularly among Black, females, and low-income patients remain low. Expanding the use of SGLT-2 inhibitors in this population could significantly improve cardiovascular outcomes.