Younger patients often ration insulin due to cost, study finds
Data from the 2021 National Health Interview Survey indicate that one in five patients younger than age 65 years, who would not be eligible for the $35 monthly Medicare price cap, have skipped or reduced insulin doses or put off buying the drug to save money.
One in five patients younger than age 65 years who have diabetes and use insulin have rationed the drug because of its cost, according to a recent study.
Researchers used data from the 2021 National Health Interview Survey to examine the prevalence of insulin rationing among U.S. adults younger than age 65 years, who would not be covered by the monthly $35 price cap for Medicare patients that was signed into law in August 2022. Telephone interviews were conducted from January to April in 2021 due to the COVID-19 pandemic, and in-person interviews were conducted afterward. Respondents were considered to have rationed insulin if they responded yes to any part of this question: “During the past 12 months, were any of the following true for you? You skipped insulin doses to save money; You took less insulin than needed to save money; You delayed buying insulin to save money.” The results were published online as a research letter March 29 by JAMA.
A total of 495 survey participants younger than age 65 years had diagnosed diabetes and reported using insulin. Their mean age was 50.7 years, and 46.8% were women. Of this group, 93 (20.4%; 95% CI, 16.2% to 25.3%) said that they had rationed insulin because of cost. Such rationing was most common in non-Hispanic Black adults, middle-income adults, and underinsured or uninsured adults. Most of the patients in the survey who said they rationed insulin were younger than age 65 years (71.1%; 95% CI, 62.0% to 78.8%). Among those rationing insulin because of cost, the percentage who were younger than 65 years was highest in patients who had type 1 diabetes (98.5%) or who were Hispanic (87.4%).
“Among US adults younger than 65 years with diabetes using insulin, 1 in 5 reported rationing insulin because of cost. Approximately 71% of all adults who reported rationing insulin because of cost were younger than 65 years and would be ineligible for out-of-pocket limits on insulin set by the Inflation Reduction Act,” the researchers wrote. They noted that recent price cuts and caps announced in March by Sanofi, Eli Lilly, and Novo Nordisk might help improve insulin affordability for younger patients, since these manufacturers make up approximately 90% of the U.S. insulin market.
A related Viewpoint, also published online by JAMA on March 29, discussed whether price caps and decreases for insulin might pave the way for reductions in drug prices overall but concluded that this was unlikely. The author noted that while changes in insulin prices may have been precipitated by political pressure, they probably would have happened anyway because of market dynamics and recent regulatory changes repealing the cap of 100% on Medicaid drug rebates. He concluded that comprehensive price negotiation is the best way to address the high costs of drugs.
“Government price setting dominates in other areas of health care, including for hospitals and physicians. Moreover, such negotiation is the rule in every other developed country, no matter whether the ruling party is liberal or conservative,” the author wrote. “The activism around insulin is laudable but does not represent an encompassing solution to the high costs of medications. That can only come with broader government price negotiation.”