Insulin use did not increase with insulin cost caps
April 11, 2024
Source: Garabedian, LF et al Ann Int Med March 26, 2024 LINK
Decreasing out of pocket costs for insulin is a good idea. Insulin is a “high value” treatment; those with Type 1 diabetes will actually die without it. Federal legislation capped out of pocket insulin cost at $35 monthly for those on a Medicare prescription plan, and 25 states have implemented caps on out-of-pocket insulin costs for those in state-regulated (fully insured) health plans. About two-thirds of those insured through employers are in self-insured plans, which are not subject to state regulation.
Researchers in the Annals of Internal Medicine studied costs and utilization of insulin for those in state regulated plans in 8 states with out-of-pocket cost caps compared to members of state regulated plans in 17 states that did not cap insulin out of pocket costs. Their total sample was 18,702 diabetic members who were on insulin. They found that those with high deductible health plans (eligible for a health savings account) paid 43% less out of pocket for insulin, while those on plans without high deductibles did not receive any out -of-pocket cost savings. Those with diabetes in the control states were more likely to live in a lower income or lower education zip code.
Data WTW published in the American Journal of Managed Care last month showed that average out of pocket spending on insulin ($27.50 monthly) was lower than out of pocket costs for other classes of brand name diabetes drugs.
The researchers found a tiny uptick in insulin utilization (1.8%), which was not statistically significant. However, they did find a statistically significant uptick (31%) in insulin fills in those on high deductible health plans who lived in lower income zip codes in states with out-of-pocket caps of $25-30.
Implications for employers
Total pharmacy costs for health plan members with Type 2 diabetes are often quite high, and the costs of insulin are just one component of that high cost.
Value based insurance design, which lowers out of pocket cost for high value services, has been demonstrated to increase adherence. While this study did not show more insulin dispensing in general, it did show benefit for those on HDHPs, especially for those on HDHPs who lived in low-income zip codes.
Policymakers and employers designing health plans should focus beyond insulin on total out-of-pocket costs for high value interventions.