Spotlight on insulin costs

A study compared patients' HbA1c levels on human and analogue insulins, a report analyzed insulin price changes between 2012 and 2016, and politicians asked pharma companies for answers.

The cost of insulin was the focus of several articles published in the past month.

One study, published by JAMA on Jan. 29, measured the effects of switching patients with diabetes (mainly type 2) from analogue to human insulin. It was a retrospective cohort study of 14,635 patients on a Medicare Advantage and prescription drug plan that began switching to human insulin in February 2015. The studied patients filled 221,866 insulin prescriptions and had a mean HbA1c level of 8.46% at baseline. Before the switch, their mean HbA1c was decreasing by 0.02% per month.

The move to human insulin was associated with an overall HbA1c level increase of 0.14% and no change in rates of serious hyperglycemia or hypoglycemia. According to the study authors, the observed increase in HbA1c may not be clinically significant and could be a result of underlying changes in clinical practice during the time period.

“The results of the current study add to a growing body of literature suggesting that human insulins may result in similar clinical outcomes compared with insulin analogues for many patients with type 2 diabetes,” they said, noting that switching even a small proportion of Medicare beneficiaries with type 2 diabetes to human insulin would lead to substantial savings in health care spending.

An accompanying editorial noted that most U.S. patients with type 2 diabetes take insulin analogues and suggested this might be due to novelty or marketing efforts. Human insulin may not work as well for patients with type 1 diabetes or risk factors for hypoglycemia and it can be more difficult to administer, according to the editorialist. The study's findings “should prompt physicians and patients to reconsider which type of insulin is best,” the editorial said.

A report published by the Health Care Cost Institute on Jan. 21 analyzed how much U.S. patients with type 1 diabetes spend on insulin. It found that gross insulin spending per patient increased by $2,841 between 2012 and 2016 to $5,705. Spending on insulin accounted for 31% of per-patient spending in 2016 and for 47% of the $6,027 increase in per-patient spending between 2012 and 2016. Analogue insulins accounted for more than 90% of the insulin use and increased slightly over the studied time period. Pre-filled insulin pens became more common as a delivery mechanism, increasing from 38% in 2012 to 46% in 2016. The price of all insulin products increased between 2012 and 2016, with the average point-of-sale price increasing from $0.13 per unit to $0.25 per unit.

In response to evidence of increasing insulin prices, two members of Congress recently wrote to insulin manufacturers, according to a recent press release from U.S. Rep. Diana DeGette (D-CO). Along with Frank Pallone, Jr. (D-NJ), she sent letters to the heads of Eli Lilly, Novo Nordisk, and Sanofi asking for the average price and net profit of each of the companies' insulin products for the past 10 years, as well as an explanation of factors that prompted any price increases and how the companies expect the overall market price of insulin to change in the next five years. The companies were given until Feb. 13 to respond.