Patients with type 1 diabetes spending more on supplies than insulin

Mean out-of-pocket spending for all care among a national sample of insured patients with type 1 diabetes was nearly $2,500 in 2018, according to one study, while a second study found that commercially insured patients' out-of-pocket insulin costs have peaked.

Two recent studies looked at the costs of insulin and other supplies for patients with diabetes.

Researchers analyzed 2018 data on patients with employer-sponsored coverage, ages one to 64 years, with continuous enrollment throughout 2018, one or more type 1 diabetes diagnosis code in 2017 (to limit the analysis to established patients), and one or more insulin claim in 2018. The results were published as a research letter in JAMA Internal Medicine on June 1.

Inpatient, outpatient, and pharmacy claims in 2018 were assigned to four categories: insulin, diabetes-related supplies such as insulin pumps and glucometers, other type 1 diabetes-related services such as medications and claims with a type 1 diabetes diagnosis code, and all other services.

The 65,192 patients who met the inclusion criteria had a mean age of 40.8 years, and 22.5% were enrolled in high-deductible health plans. This included 7,842 children (ages 1 to 17 years). The patients' mean ± SD annual out-of-pocket spending for insulin was lower ($435 ± $544) than for diabetes-related supplies ($490 ± $785). Mean ± SD annual overall out-of-pocket spending was $2,414 ± $3,531, but 8.0% of patients spent more than $5,000. Insulin accounted for 18.0% of overall out-of-pocket spending. Mean annual out-of-pocket spending for diabetes-related supplies varied by whether patients used insulin pumps only ($562 ± $626), continuous glucose monitors only ($472 ± $625), both ($1,037 ± $1,039), or neither ($79 ± $175). Overall, 56.8% of patients used insulin pumps, continuous glucose monitors, or both.

“Findings suggest that substantial out-of-pocket burden may remain for patients with type 1 diabetes even if insulin cost-sharing is limited,” the authors concluded. “Government officials and insurers should consider improving coverage for all type 1 diabetes-related services, following the approach of a 2019 rule allowing qualified high-deductible health plans to cover services such as insulin and glucometers before deductibles are met.”

A second research letter in the same issue found that out-of-pocket insulin costs for privately insured patients across the U.S. peaked in 2013 and 2014, at $72 per member per month for all insulin users and $150 per member per month for those in high-deductible health plans with a health savings account, respectively. Overall insulin costs continued to rise through 2017, but insurers spread the costs across their members, according to the study.

An editorial accompanying both studies stated, “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.”