Report Publish Date: July 1, 2022
This issue brief summarizes the results of a study that looked at how high out-of-pocket costs of insulin affected patients’ likelihood of staying on their insulin regimen.
The study was published in the Journal of Managed Care and Specialty Pharmacy in May 2022.
Many patients had at least one long gap (60 days) in their insulin supply. Patients with higher out-of-pocket costs were more likely to have long gaps in supply. Patients with type 1 and type 2 diabetes who paid more than $50 for 30-days-worth of insulin were most likely to have long gaps in supply. For patients with type 2 diabetes, costs greater than $35 also were likely to lead to supply gaps.
About 30% of the 30 million people in the U.S. with diabetes take insulin. But many people stop taking it or ration it because it's too expensive. Out-of-pocket costs for insulin vary widely, and 15 states have passed laws limiting, or capping, the cost in state-regulated insurance plans.
The authors wanted to provide data that informs discussions about insulin out-of-pocket caps.
The authors wanted to examine the relationship between the cost of insulin to patients and their likelihood of not taking it as prescribed. The researchers also analyzed at what price point patients were more likely to have gaps in their insulin supply.
“Between 35% and 45% of patients had at least one 60-day gap in insulin supply, and gaps were more likely to occur for patients with higher out-of-pocket costs.”
—Carrie McAdam-Marx, University of Nebraska, and Natalia Ruiz-Negron, University of Utah
“[T]his study suggests that plans may be able to reduce the risk of nonadherence while maintaining a modest out-of-pocket cost (<$35 per 30-day supply),” the authors write.
Insulin can be a life-saving drug, but high drug costs can lead people with diabetes to stop taking or ration their insulin. Insulin non-adherence can have significant consequences. For instance, other studies have identified that those who do not take insulin as prescribed have higher rates of complications and hospitalizations than those who adhere to their insulin therapy. In response, 15 states have passed laws limiting insulin out-of-pocket costs in state-regulated insurance plans, with caps generally ranging from $25 to $100 per 30-day supply. While proposed, there is currently no national-level legislation that limits insulin out-of-pocket costs for insured patients.
To better understand the impact of rising insulin costs on patients and to inform discussions related to insulin out-of-pocket caps, Carrie McAdam-Marx, Professor in the College of Pharmacy at the University of Nebraska Medical Center, Natalia Ruiz-Negron, Research Assistant Professor in the College of Pharmacy at the University of Utah, and colleagues examined the association between insulin out-of-pocket costs and the use of insulin and non-insulin diabetes medications, as well as the association with other diabetes-related outcomes. Full study details and findings are available in the Journal of Managed Care and Specialty Pharmacy, Volume 28, Issue 5 (May 2022).
Academy Health, July 2022
Proportion of patients with a 60-day gap in insulin supply over the follow-up year by insulin out-of-pocket costs
This study and report was conducted and created by the following people:
