High costs of insulin lead to rationing of diabetic patients

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High costs of insulin lead to rationing of diabetic patients

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Elderly patients with diabetes will stagger insulin use because of cost.

Insulin prices have been in the national news since at least last summer, when President Joe Biden signed the federal Inflation Reduction Act into law in August 2022. That law caps the cost of insulin at $35 a month for Medicare beneficiaries.

For those not yet old enough for Medicare, about 20% of patients allocate their use, with cost-related allocation most common among non-Hispanic blacks, middle-income, and underinsured or uninsured adults.

The findings were in the research letter “Cost-Related Insulin Dosing in US Adults Younger than 65 Years of Age with Diabetes,” by Michael Fang, MD, MHS, and Elizabeth Selvin, MD, MPH, published this spring in JAMA. The data comes from the 2021 National Health Interview Survey, which used a combination of telephone and in-person interviews due to the COVID-19 pandemic.

Participants were asked if they agreed: “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.

Underutilization of insulin has important clinical implications, the researchers said. They cite studies that found that from 2005 to 2012, 30.3% of American adults treated with insulin and 12.1% of adults treated with insulin and oral diabetes medications met the typical hemoglobin A1C goal of less than 7%. “From 2009 to 2015, hospitalizations for diabetic ketoacidosis increased from 24.4 to 43.5 per 1,000 adults with diabetes among those aged 18 to 44,” the study said.

As for the effects of the Inflation Reduction Act, “expanding copayment limits to all patients using insulin is likely to improve affordability,” the researchers said. Younger diabetes patients would get some price breaks without this federal action.

On March 1, drugmaker Eli Lilly capped the out-of-pocket cost of insulin at $35 a month for patients with commercial insurance or the uninsured. That same month, Novo Nordisk cut the list prices of its most-prescribed insulins by up to 75%, while Sanofi set its monthly co-payment for insulin at $35 a month.

“These changes may improve affordability for patients not covered by the Inflation Reduction Act, as these (three) manufacturers make up approximately 90% of the US insulin market,” the study said.

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