Private plans shield members from out-of-pocket insulin costs
The other study examined out-of-pocket spending for 10,954,436 insulin claims for 612,071 unique patients with diabetes (either type) in different types of private commercial health plans during 2006-2017:
- High-deductible health plans (HDHP) with a health savings account (HSA), which have high medication costs because they require payment of the full reimbursement price until the annual deductible is reached (7% of claims).
- Plans with health reimbursement arrangement (HRA), which typically have tiered drug copayments and members can use their reimbursement accounts to pay for medical expenses (4% of claims).
- No-account plans (without an HSA) that also typically have tiered drug copayments (80% of claims).
The price of insulin per patient per month rose from $143 in 2006 to $280 in 2012 to $394 in 2017.
However, the share of the insulin price per member per month paid by the patient actually declined from 24% in 2006 to 16% in 2012 to just 10% in 2017.
Because of the increase in insulin price, those corresponding costs still rose from $52 in 2006 to $72 in 2012, but then dropped to $64 in 2017.
By plan type, out-of-pocket costs per member per month were lowest for those no-account plans (from $52 in 2006 to $48 in 2017) and highest for those with HDHP HSA plans ($93 in 2006 to $141 in 2017).
“The data suggest that privately insured patients have been relatively shielded from insulin price increases and that commercial health insurers have accommodated higher insulin prices by increasing premiums or deductibles for all members,” Dr. Meiri and colleagues write.
Most vulnerable missing from study: COVID-19 will strike further blow
Although generally agreeing with this conclusion, Dr. Nally and Dr. Lipska nevertheless faulted the data from Dr. Meiri and colleagues on several counts.
First, they reiterated that the population was limited to those with private insurance plans, and therefore “the groups most vulnerable to high insulin costs may be missing from the study.”
Also, the data do not capture all sources of out-of-pocket insulin spending for people with high copayments, such as the federal 340B Drug Pricing Program, GoodRx, or drug manufacturer discounts.
Moreover, the editorialists noted, the study assessed only mean out-of-pocket costs without assessing differences in spending across individuals.
And, Dr. Nally and Dr. Lipska pointed out, the data do not account for rebates and discounts negotiated between pharmacy benefit managers and drug manufacturers. “As a result, these data on health plan spending on insulin may overestimate the net health plan expenditures,” they wrote.
Dr. Chua also warned that the COVID-19 pandemic has had a major adverse impact on the diabetes community.
“Many people with private insurance have lost their jobs and insurance coverage ... This may put health care like insulin and diabetes-related supplies out of reach,” he said.
Dr. Chua has reported receiving support from the National Institute on Drug Abuse. Dr. Meiri has reported receiving grants from the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases for the study. Dr. Nally has reported receiving a grant from Novo Nordisk outside the submitted work. Dr. Lipska has reported receiving support from the Centers for Medicare & Medicaid Services and the National Institutes of Health.
A version of this article originally appeared on Medscape.com.