Researchers looked at trends in insulin usage and expenditure among insured and uninsured populations with diabetes, accounting for how the expansion of Medicaid under the Affordable Care Act may have affected these trends.
While insulin usage was stable between 2009 and 2018, total insulin expenditure nearly doubled per person per year after the passing of the Affordable Care Act (ACA), regardless of insurance status.
Among individuals with diabetes who had insurance, this increasing financial burden was covered by insurance, with out-of-pocket (OOP) costs remaining stable in this group. However, for individuals without insurance, increasing OOP payments became an immediate burden, increasing by 1.7 times along with the increased insulin price.
“Policymakers should take action to reduce the insulin price and improve the transparency of the insulin pricing process,” said the authors of the study, published in the Journal of Diabetes.
The authors used data from the 2009-2018 Medical Expenditure Panel Survey (MEPS) to measure trends in insulin expenses, as well as total per-person expenditures and OOP costs on insulin and noninsulin glucose-lowering medications among individuals with and without insurance. They then used multivariable regression to see how insulin OOP payment and insurance status was associated with glucose-lowering medication OOP expenditure. A total of 13,696 participants were included from the MEPS data.
Of note, the ACA was initially enacted March 2010, and the expansion of Medicaid and launch of health insurance marketplaces for private coverage went into full effect in 2014. To add this context to their findings, the study authors referred to the 2009-2013 period as pre-ACA, and the 2014-2018 period as post ACA.
They found that prevalence of insulin purchase among participants with diabetes had a small growth from 25.46% in 2009 to 29.07% in 2018. Prevalence of insulin purchase peaked in 2014 at 32.59%, potentially due to the ACA expansion.
Median OOP cost of insulin for individuals without insurance increased from $1678 per person per year pre-ACA to $2800 per person per year post ACA. For individuals with insurance, these OOP costs decreased from $1595 pre-ACA to $1226 post ACA.
The implementation of the ACA also increased the overall expenditure on glucose-lowering medications by $266.30. After the implementation, individuals without insurance also had $403.96 and $143.64 higher OOP costs compared with individuals with public and private insurance, respectively.
“These statistics indicated that the ACA did alleviate the OOP cost for the insured population; however, for the uninsured population, the impact of the ACA was exacerbated,” the authors said.
It is important to note some limitations to this study. First, it used patient-reported data from a national survey with a response rate between 42.7% and 57.2%. Second, MEPS data did not include information on insulin use adherence and appropriateness. Third, data on use of free medication samples, insurance premiums, and paid tax amounts were not available and therefore not included in analyses.
The authors noted that both government and industry are making efforts to decrease insulin costs and increase insulin availability.
“It is imperative to slow down the increasing expenditure trend by reducing insulin costs,” the authors concluded. “Additionally, more supportive policies should be implemented for the uninsured diabetes population to get enough necessary insulin usage.”
Lin Y, Shao H, Fonseca V, Shi L. Exacerbation of financial burden of insulin and overall glucose-lowing medications among uninsured population with diabetes. J Diabetes. Published online February 7, 2023. doi:10.1111/1753-0407.13360