Out of pocket costs are high for diabetes drugs other than insulin
March 11, 2024
Source: Quach, et al AJMC 3/5/24 LINK
There has been a huge amount of attention on the cost of insulin - without which people with Type 1 Diabetes would die. There have been Congressional hearings and proposed legislation to cap out-of-pocket costs, and the major insulin makers announced large price cuts last fall which went into effect early this year.
There’s been much less attention to the high out-of-pocket and total cost of other effective drugs for diabetes, but these, too, can break patients’ budgets.
My colleagues Chantell Sell, Pharm D, Cody Midlam, Pharm D, Jennie Quach, MBA and I published a research letter in the American Journal of Managed Care this week using data from the RxCollaborative to demonstrate out of pocket costs for other classes of medications to treat diabetes. We focused on four categories of diabetes drugs: Insulin, SGLT-2 medications (like Jardiance), GLP-1 medications (like Ozempic), and DPP-4 inhibitors (like Januvia). There are other classes of diabetes drugs, but they are either rarely used or are generics and likely have low out of pocket costs. These newer classes of medications are much more effective clinically compared to most older andand cheaper diabetes medications.
We found that people with diabetes had higher out of pocket costs for non-insulin diabetes drugs than for insulin in 2021. The problem was most severe for those who were on three or more classes of medications; these patients had average out of pocket costs for medications of $1138 a year, and the top 10% of patients on three or more classes of drugs for diabetes spent almost $3000 on drugs out of pocket annually. People with diabetes also face out of pocket costs for office visits and test strips or other supplies, too. This analysis did not include drugs that were prescribed but not picked up at the pharmacy.
Implications for employers:
Value based insurance design plans that offer lower out of pocket costs for effective diabetes medications can decrease financial insecurity due to out-of-pocket drug costs. Some studies even show that these programs can lower total medical expenses.
Making drugs for diabetes affordable for members can increase adherence and help prevent emergency department visits, hospitalizations, and diabetes complications.
Rebates worsen the out of pocket cost burden, because members are charged cost sharing based on a medication’s price before rebates.
The underlying problem is that the acquisition costs of pharmaceutical products is too high in the United States. Employers that increase drug subsidies ease the burden of drug costs for those with diabetes but may be forced to increase premiums or increase cost sharing for other services.
Thanks for reading. You can find previous posts in the Employer Coverage archive
Please subscribe, “like” and suggest this newsletter to friends and colleagues. Thanks!
Tuesday: Morgan Health report highlights challenges for lower income employees