Despite increasing cost of insulin, out-of-pocket expenses stable from 2006-2017

1. Insulin costs steadily increased from 2006-2017. However, the out-of-pocket costs to privately insured patients remained consistent, in-part due to decreased cost-sharing.

2. Privately insured consumers with health savings accounts (HSAs) paid significantly more in out of pocket costs in comparison to those with health reimbursement arrangements (HRAs) or no-account plans.

Evidence Rating Level: 3 (Average)

Study Rundown: In order to study trends in insulin costs for privately insured patients, a retrospective analysis of data from more than 612,000 patients was performed. This study determined that while insulin costs rose steadily from 2006-2017, patient reimbursement share requirements decreased. Thus, monthly out of pocket expenses for privately insured patients remained relatively consistent.  Further, the authors stratified this data based on health insurance type (high deductible HSAs, HRAs, and no-account plans).  It was determined that patients with HSAs were responsible for significantly higher monthly out of pocket expenses than those with HRAs.  Patients with no-account plans paid the least per month for insulin. This study had a number of limitations.  Patient demographics were not listed and the majority of patients included in this study had a no-account plan (80%), while only 4% had an HSA.  Additionally, patients who were uninsured or a recipient of medicare or medicaid were not included.

Click to read study, published today in JAMA

Relevant Reading: Cost-Related Insulin Underuse Among Patients With Diabetes

In-Depth [retrospective cohort]: The rising costs of a number of critical pharmaceutical agents, insulin in particular, has been a subject of discussion and attempted reform for many years. In order to study trends in insulin costs, retrospective data analysis was performed using information from more than 612,000 patients obtained through Optum’s Deidentified Clinformatics Data Mart Database from 2006-2017.  Patients were privately insured, had a diabetes diagnoses, and had a record of prior insulin prescription fills. Patients without insurance benefit design data were excluded.

Accounting for inflation, it was determined that monthly insulin prices have increased from $143/month in 2006 to $394/month in 2017, which is a mean increase of $23 per year.  Out of pocket expenses have remained in the range of $36-$45 per month, despite this increase.  This consistency can likely be explained by consistent decreases in the share of insulin costs for which privately insured patients are responsible for.  In 2006, patients were responsible for 24% of insulin costs, this share has decreased to 10% as of 2017.  Patients with an HSA plan pay significantly more than those with an HRA or no-account plan ($141/month, $108/month, $48/month, respectively, in 2017).

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