For privately insured individuals with type 1 diabetes in the United States, out-of-pocket costs for insulin are typically lower than for other diabetes-related supplies. But overall out-of-pocket expenditure – taking into account everything that is needed to manage diabetes – is still very high.
Indeed, insulin costs have remained relatively stable over time in such private insurance plans, according to another analysis that looked at all types of diabetes.
Those are the findings of two separate research letters published June 1 in JAMA Internal Medicine.
The first research letter examined all costs for privately insured patients with type 1 diabetes, finding a mean out-of-pocket spend of approximately $2,500 a year.
“Insulin is the difference between life and death for patients with type 1 diabetes, and efforts to make it more affordable are critical,” said lead author of the first letter, Kao-Ping Chua, MD, PhD, of the department of pediatrics, University of Michigan, Ann Arbor.
“However, our study shows that even if insulin were free, families would still have substantial out-of-pocket costs for other health care,” he noted in a press release from his institution.
The other research letter examined trends in insulin out-of-pocket costs in 2006-2017 among U.S. patients with any type of diabetes who had different types of private health insurance plans. The study was by Amir Meiri, MD, of Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, and colleagues.
Although the study showed relatively stable costs associated with insulin for many privately insured patients with diabetes over the time period examined, “monthly out-of-pocket payments” may still “be burdensome for low-income individuals,” the authors said.
Writing in an accompanying editorial, Laura M. Nally, MD, and Kasia J. Lipska, MD, both of Yale University, New Haven, Conn., agreed that “insulin is only one component of diabetes management.”
Yet they stressed: “Diabetes does not selectively occur among individuals who can afford insulin and who have health insurance; it affects people regardless of their socioeconomic status.”
“The federal health care system should urgently act to make insulin, diabetes-related supplies, and other health care services affordable and available to everyone who needs them.”
Out-of-pocket costs for supplies higher than for insulin
Dr. Chua and colleagues compared out-of-pocket costs for insulin with those for other diabetes-related items, including insulin pump supplies, and glucose meters/continuous monitors, for privately insured patients with type 1 diabetes during 2018.
They included data for 65,192 patients aged 1-64 years with type 1 diabetes who had employer-sponsored coverage from medium to large firms.
The population included children of employees (12%), and 22.5% of patients had enrolled in high-deductible ($1,350 individual/$2,700 family) private plans. Overall, 56.8% used insulin pumps and/or continuous glucose monitors (CGMs).
Annual out-of-pocket spending was lower for insulin ($435) than other diabetes-related supplies ($490), including insulin pump supplies, continuous and fingerstick glucose monitoring equipment, urine testing strips, pen needles, and syringes.
Mean annual overall out-of-pocket spending was $2,414, but this varied widely.
For 8% of the population spending exceeded $5,000. Insulin accounted for just 18% of overall out-of-pocket spending.
Not surprisingly, out-of-pocket spending increased with the sophistication of the diabetes technology used, ranging from just $79 for those using injections and fingerstick monitoring to $1,037 for those using both insulin pumps and CGMs.
In general, for children, out-of-pocket costs of diabetes-related supplies were considerably higher than for insulin ($823 vs. $497), while for adults the two were similar ($445 vs. $427).
“These technologies can improve quality of life and improve diabetes control for all patients, but can be especially important to the families of children with type 1 diabetes,” Dr. Chua said.
Also not surprisingly, those with high-deductible plans had greater out-of-pocket costs in each category ($3,132 vs. $2,205 overall).
Dr. Chua said the study’s findings are particularly timely given recent efforts by states and insurers to cap out-of-pocket costs for insulin, calling these “important first steps.”
But there is still a long way to go, he said.
“Policymakers should improve the affordability of all care for type 1 diabetes,” Dr. Chua noted.
Dr. Nally and Dr. Lipska agreed.
“Although capping insulin copayments is a step in the right direction, such a state law does not protect many individuals with federally regulated insurance plans, with Medicare, or without any insurance,” they noted.
“In addition, insulin copayment caps do little to ease the financial burden of paying for diabetes-related supplies or other healthcare services,” they pointed out.