Catastrophic Spending On Insulin In The United States, 2017–18

Bakkila, Baylee F.; Basu, Sanjay; Lipska, Kasia J.

doi:10.1377/hlthaff.2021.01788

Cited by 14 publications

(7 citation statements)

References 13 publications

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“…Approximately two thirds of people who experienced this high spending on insulin were Medicare beneficiaries. 23 Insulin expenditure is a great burden even for the insured population with government assistance. How this high OOP payment affects the uninsured population is imaginable.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study found that 14.1% of insulin users spent 40% of their postsubsistence family income on insulin alone over 1 year, representing almost 1.2 million people. Approximately two thirds of people who experienced this high spending on insulin were Medicare beneficiaries 23 . Insulin expenditure is a great burden even for the insured population with government assistance.…”

Section: Discussionmentioning

confidence: 99%

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Exacerbation of financial burden of insulin and overall glucose‐lowing medications among uninsured population with diabetes

Lin

Shao

Fonseca

et al. 2023

Journal of Diabetes

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Background Approximately 7.4 million Americans with diabetes used insulin. This study aimed to document the 10‐year trend of insulin and other glucose‐lowering medications expenditure among insured and uninsured populations and to examine the impact of insulin out‐of‐pocket (OOP) payment and insurance status on glucose‐lowering medication OOP expenditure. Methods We extracted data from the Medical Expenditure Panel Survey (2009–2018) to document trends in the expenditure of insulin among people with diabetes. Total expenditures and OOP spending per person were documented on insulin and noninsulin glucose‐lowering medications among insured and uninsured populations. Multivariable regression was applied to assess the association of insulin OOP payment and insurance status on glucose‐lowering medication OOP expenditure. Results Although insulin usage was stable over the decades, total insulin expenditure almost doubled per person per year after the Affordable Care Act (ACA) regardless of the insurance status. The OOP cost of insulin by the uninsured population increased from $1678 per person per year in the pre‐ACA period to $2800 per person per year in the post‐ACA period. After the ACA was enacted, the uninsured population had $403.96 and $143.64 more on OOP costs than the people with public and private insurance, respectively. Conclusion For insured people, the rising financial burden of insulin was borne mainly by insurance. The uninsured population is bearing a heavy burden due to the high price of insulin. Policymakers should take action to reduce the insulin price and improve the transparency of the insulin pricing process.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Exacerbation of financial burden of insulin and overall glucose‐lowing medications among uninsured population with diabetes

Lin

Shao

Fonseca

et al. 2023

Journal of Diabetes

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“…High out-of-pocket (OOP) drug costs are identified as a factor that limit initiation of and adherence to prescribed glucose lowering therapies . For example, studies have shown that cost-related nonadherence affects up to 1 in 4 insulin users . Much less is known about the association of high OOP drug costs and use of newer (noninsulin) glucose lowering therapies for patients with T2D .…”

Section: Introductionmentioning

confidence: 91%

“… 8 , 9 , 10 , 11 , 12 For example, studies have shown that cost-related nonadherence affects up to 1 in 4 insulin users. 13 , 14 Much less is known about the association of high OOP drug costs and use of newer (noninsulin) glucose lowering therapies for patients with T2D. 6 In prior work from a large integrated health system, we showed that one third of patients newly prescribed an SGLT2 inhibitor or GLP-1 RA did not fill their prescription within 30 days.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Out-of-Pocket Costs and Treatment Intensification With an SGLT2 Inhibitor or GLP-1 RA in Patients With Type 2 Diabetes and Cardiovascular Disease

et al. 2023

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ImportanceThe latest guidelines continue to recommend sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for patients with type 2 diabetes (T2D) and established cardiovascular disease (CVD). Despite this, overall use of these 2 drug classes has been suboptimal.ObjectiveTo assess the association of high out-of-pocket (OOP) costs and the initiation of an SGLT2 inhibitor or GLP-1 RA among adults with T2D and established CVD who are treated with metformin-treated.Design, Setting, and ParticipantsThis retrospective cohort study used 2017 to 2021 data from the Optum deidentified Clinformatics Data Mart Database. Each individual in the cohort was categorized into quartiles of OOP costs for a 1-month supply of SGLT2 inhibitor and GLP-1 RA based on their health plan assignment. Data were analyzed from April 2021 to October 2022.ExposuresOOP cost for SGLT2 inhibitors and GLP-1 RA.Main Outcomes and MeasuresThe primary outcome was treatment intensification, defined as a new dispensing (ie, initiation) of either an SGLT2 inhibitor or GLP-1 RA, among patients with T2D previously treated with metformin monotherapy. For each drug class separately, Cox proportional hazards models were used to adjust for demographic, clinical, plan, clinician, and laboratory characteristics to estimate the hazard ratios of treatment intensification comparing the highest vs the lowest quartile of OOP costs.ResultsOur cohort included 80 807 adult patients (mean [SD] age, 72 [9.5] years, 45 129 [55.8%] male; 71 128 [88%] were insured with Medicare Advantage) with T2D and established CVD on metformin monotherapy. Patients were followed for a median (IQR) of 1080 days (528 to 1337). The mean (SD) of OOP costs in the highest vs lowest quartile was $118 [32] vs $25 [12] for GLP-1 RA, and $91 [25] vs $23 [9] for SGLT2 inhibitors. Compared with patients in plans with the lowest quartile (Q1) of OOP costs, patients in plans with the highest quartile (Q4) of costs were less likely to initiate a GLP-1 RA (adjusted HR, 0.87 [95% CI, 0.78 to 0.97]) or an SGLT2 inhibitor (adjusted HR, 0.80 [95% CI, 0.73 to 0.88]). The median (IQR) number of days to initiating a GLP-1 RA was 481 (207-820) days in Q1 and 556 (237-917) days in Q4 of OOP costs and 520 (193-876) days in Q1 vs 685 (309-1017) days in Q4 for SGLT2 inhibitors.Conclusions and RelevanceIn this cohort study of more than 80 000 older adults with T2D and established CVD covered by Medicare Advantage and commercial plans, those in the highest quartile of OOP cost were 13% and 20% less likely to initiate a GLP-1 RA or SGLT2 inhibitor, respectively, when compared with those in the lowest quartile of OOP costs.

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“… 1 Some of the highest costs are associated with insulin for which prices have increased >200% between 2008-2017. 2 Cost-related underuse affects almost 25% of patients prescribed insulin for diabetes. 3 The increasingly high cost of diabetes medications can be a barrier for patients in achieving glycemic control and preventing complications.…”

Section: Objectives/introductionmentioning

confidence: 99%

Community Health Center 340B Program: A Qualitative Study of the Experiences of Patients with Diabetes

Wagner,

Whitner,

Williams

et al. 2023

Innov Pharm

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Background: The 340B Drug Pricing Program provides discounted drug prices to safety-net entities which help stretch scarce resources to expand comprehensive services and treat more vulnerable patients. The program has received criticism questioning whether the original intentions are being accomplished. Objective: This qualitative study aimed to understand lived experiences of patients accessing high-cost injectable diabetes medication(s) through a 340B Prescription Cash Discount Program (PCDP) provided at a community health center. Methods: This qualitative study utilized semi-structured individual interviews. We invited patients ≥18 years old with diabetes for >1 year who utilized the 340B PCDP to fill an injectable diabetes medication at least twice between 3/1/2020-3/1/2021 to participate. Trained personnel interviewed ten participants in 11/2021-2/2022 and completed thematic analysis of the transcribed interviews. Results: Themes included 340B feedback, benefits of 340B, consequences of being without 340B, community pharmacy experience, and use of other services. Participants deemed the 340B program as a “lifesaver.” Perceived benefits of the program included improved diabetes control and savings that made their prescriptions more affordable. Consequences of being without the program include that medication was too expensive to take as prescribed and rationing/skipping doses. Participants were pleased with the accessibility of the network of contract pharmacies and described benefiting from services supported by 340B savings. Conclusions: Recent criticisms question whether the 340B program accomplishes its original intentions of stretching scarce federal resources to help safety-net entities expand services and treat more patients. This study provides insight into the personal impact of the 340B program on underserved patients with chronic disease accessing high-cost medication(s). Findings highlight crucial strengths of the program from the patient perspective, which policymakers and other stakeholders should consider to provide support for the continuation of these services.

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Catastrophic Spending On Insulin In The United States, 2017–18

Cited by 14 publications

References 13 publications

Exacerbation of financial burden of insulin and overall glucose‐lowing medications among uninsured population with diabetes

Exacerbation of financial burden of insulin and overall glucose‐lowing medications among uninsured population with diabetes

Evaluation of Out-of-Pocket Costs and Treatment Intensification With an SGLT2 Inhibitor or GLP-1 RA in Patients With Type 2 Diabetes and Cardiovascular Disease

Community Health Center 340B Program: A Qualitative Study of the Experiences of Patients with Diabetes

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