State Out-Of-Pocket Caps On Insulin Costs: No Significant Increase In Claims Or Utilization.

Nearly all patients with type 1 diabetes and 20-30 percent of patients with type 2 diabetes use insulin to manage glycemic control. Approximately one-quarter of patients who use insulin report underuse because of cost. In response, more than twenty states have implemented monthly caps on insulin out-of-pocket spending, ranging from $25 to $100. Using a difference-in-differences approach, this study evaluated whether state-level caps on insulin out-of-pocket spending change insulin usage among commercially insured enrollees. The study included 33,134 people ages 18-64 who had type 1 diabetes or who used insulin to manage type 2 diabetes with commercial insurance coverage that was subject to state-level oversight and was included in the 25 percent sample of the IQVIA PharMetrics database during 2018-21. Insulin out-of-pocket caps did not significantly increase quarterly insulin claims for enrollees who had type 1 diabetes or who used insulin to manage type 2 diabetes. State-level caps on insulin out-of-pocket spending for commercial enrollees did not significantly increase insulin use; that may be in part because of out-of-pocket expenses being lower than cap amounts.

Effect of Arrival of Prior Mammograms on Recall Negation for Screening Mammograms Performed With Digital Breast Tomosynthesis in a Clinical Setting.

PURPOSE: This retrospective study evaluates the effect of comparison with prior mammograms on recall negation for screening mammography performed with digital breast tomosynthesis (DBT) in a clinical setting and compares it with that performed without DBT. METHODS: This is an Institutional Review Board-approved, HIPAA-compliant retrospective review of the electronic medical record for all nonbaseline screening mammograms performed in clinical practice over 13 months. For each mammogram, we recorded if DBT were used, the BI-RADS assigned at initial interpretation, and whether prior mammograms were available at initial interpretation. If prior mammograms arrived later for comparison, the final BI-RADS assigned after comparison was recorded. A mammogram assigned a BI-RADS 0 at initial interpretation and assigned a BI-RADS 1 or BI-RADS 2 after prior mammograms arrived for comparison was labeled as a recall that was negated by the arrival of prior mammograms. The number of recalls negated for mammograms that used DBT was compared with that for mammograms that did not use DBT. RESULTS: Arrival of prior mammograms for comparison negated the need for recall for mammograms performed with DBT by 67.67% and negated the need for recall for mammograms performed without DBT by 55.80%. After adjusting for age, density, and time between mammograms, the percentage of recalls negated by comparison with prior mammograms was not significantly different for mammograms performed with DBT than it was for those performed without DBT. CONCLUSION: Comparison with prior mammograms remains important for the minimization of recall rates during the use of DBT for screening mammography in the clinical setting.

Sex disparities in substance abuse research: Evaluating 23 years of structural neuroimaging studies.

BACKGROUND: Sex differences in brain structure and clinical course of substance use disorders underscores the need to include women in structural brain imaging studies. The NIH has supported the need for research to address sex differences. We evaluated female enrollment in substance abuse structural brain imaging research and the methods used to study sex differences in substance effects. METHODS: Structural brain imaging studies published through 2016 (n=230) were evaluated for number of participants by sex and substance use status and methods used to evaluate sex differences. Temporal trends in the numbers of participants by sex and substance use status were analyzed. We evaluated how often sex effects were appropriately analyzed and the proportion of studies that found sex by substance interactions on volumetric measures. RESULTS: Female enrollment increased over time, but remained significantly lower than male enrollment (p=0.01), with the greatest bias for alcohol and opiate studies. 79% of studies included both sexes; however, 74% did not evaluate sex effects or used an analytic approach that precluded detection of sex by substance use interactions. 85% of studies that stratified by sex reported different substance effects on brain volumes. Only 33% of studies examining two-way interactions found significant interactions, highlighting that many studies were underpowered to detect interactions. CONCLUSIONS: Although female participation in substance use studies of brain morphometry has increased, sex disparity persists. Studying adequate numbers of both sexes and employing correct analytic approaches is critical for understanding sex differences in brain morphometric changes in substance abuse.

Compliance With Screening Mammography Guidelines After a False-Positive Mammogram.

PURPOSE: To assess whether women with a false-positive mammogram who do return for screening are less likely to be compliant with screening mammography guidelines than are women with a negative mammogram. METHODS: This institutional review board-approved, HIPAA-compliant retrospective cohort study includes women >40 years old who received 9,385 consecutive, nonbaseline screening mammograms between December 1, 2012 and December 31, 2013. Using linear regression, we evaluated differences in time between mammograms by prior recall status, after adjusting for location of current mammogram (outpatient office versus mobile unit) and age. Using Fisher's exact test, we evaluated the association between compliance with screening guidelines and the recall status on prior mammogram, and compared by location the proportions of noncompliant women who were recalled from prior mammogram. RESULTS: Time between mammograms does not differ based on prior recall status (P = .83). There is no association between compliance with screening mammography guidelines and recall status on prior mammogram (ACR guidelines P = .398, United States Preventive Services Task Force guidelines P = .416). Noncompliant women recalled on prior mammogram are more likely to undergo mammography at the outpatient office rather than the mobile unit (ACR guidelines P = .0004, United States Preventive Services Task Force guidelines P = .0032). CONCLUSIONS: A prior false-positive mammogram is not a significant deterrent to compliance with screening guidelines in those women who return for screening.