Out-of-Pocket Spending on Insulin Tripled in 11 Years

Commentary by lead researcher Philip Clarke, Ph.D., professor of Health Economics at the University of Melbourne, Australia.

People with type 2 diabetes who use insulin saw out-of-pocket expenses for this essential blood sugar-lowering drug triple between 2002 and 2013, according to a new study published today in the Journal of the American Medical Association. In contrast, prices for other widely-used diabetes medications rose slightly or even dropped.

insulin prices

Spending for insulin in the United States increased from $231 a year in 2002 to $736 a year in 2013 for people with type 2 diabetes. They spent more on insulin, per person, than on all other diabetes drugs combined. Lead researcher Philip Clarke, Ph.D., professor of Health Economics at the University of Melbourne, Australia, told EndocrineWeb.com in an email interview that the rise could make it difficult for people on a tight budget to stick with their insulin treatment as prescribed by their doctor. “When a patient pays for a significant proportion of the cost of insulin, price changes may impact compliance and this may have negative impact on a patient’s health,” he says.

The researchers analyzed prescription-drug information from 27,878 Americans with type 2 diabetes who had participated in the U.S. government’s huge, annual Medical Expenditure Panel Surveys. Nearly 30% used insulin. The researchers did not include people with type 1 diabetes, who typically use more insulin than those with type 2 diabete. The study is notable because it looks at what people with and without health insurance actually paid for their diabetes medications. It found that:

  • The price of insulin rose from $4.34 per milliliter in 2002 to $12.92 per ml in 2013.
  • Spending for analog insulins – more expensive types with formulas designed to reduce risk for low blood sugar and for insulin spikes – rose to $508 by 2013. Less-expensive human insulin cost $228 a year.
  • The amount of insulin people with type 2 diabetes used rose from 171 ml in 2002 to 206 mL in 2013. Those with type 2 diabetes were using more insulin by the end of the study to hit newer, lower blood-sugar targets. 
  • At the same time, the cost of the popular diabetes drug metformin fell 93%—from $1.21 per pill in 2002 to 31 cents per pill in 2013. And the cost of DPP-4 inhibitors (such as alogliptin (Nesina), linagliptin (Tradjenta) saxagliptin (Onglyza) and sitagliptin (Januvia))1 rose 34%.  

Dr. Clarke says doctors and other healthcare practitioners should take a second look at these and other diabetes drugs for those who are struggling to afford insulin. “A key factor behind the increased prescribing of insulin has been its use in treating people with type 2 diabetes,” he says. “There are now a wide range of treatment options for people with type 2 diabetes including several types of new oral therapies. Some of these newer therapies such as empagliflozin (Jardiance, Glyxambi, Synjardy)2 have recently been shown to have significant benefits including lowering the risk of cardiovascular disease and mortality. The incremental benefit and cost of using insulin should be assessed alongside other treatment options.”


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