Out-of-pocket caps do not increase insulin use in type 1 or type 2 diabetes
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Key takeaways:
- State-level out-of-pocket insulin caps did not boost prescription fills for insulin among adults with commercial insurance.
- Some people still averaged more than $50 in monthly out-of-pocket costs post-cap.
States that approved caps to limit out-of-pocket costs for insulin did not have increased uptake in insulin use among people with diabetes and commercial insurance, according to findings published in Health Affairs.
As Healio previously reported, Colorado was the first state to pass a cap limiting out-of-pocket insulin expenses for people with diabetes in May 2019. In a retrospective analysis, researchers collected data from the IQVIA PharMetrics Plus for Academics claims database to assess whether state-level insulin caps imposed in Colorado and 13 other states increased insulin uptake for people younger than 64 years with type 1 diabetes or insulin-treated type 2 diabetes who had commercial health insurance.
“State-level caps on insulin out-of-pocket costs do not meaningfully increase insulin utilization,” Kelly E. Anderson, PhD, assistant professor and director of the pharmaceutical outcomes research PhD program in the department of clinical pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences at University of Colorado Anschutz Medical Campus, told Healio. “Our research shows this is likely due in part to many commercial enrollees paying out-of-pocket amounts below the cap levels even prior to cap implementation.”
Anderson and colleagues collected a 25% random sample of data of people who were continuously enrolled in a commercial insurance plan from 2018 to 2021. Multiple difference-in-difference analyses were performed. Researchers compared insulin fills for people with diabetes in Colorado with those living in states without an insulin cap as of December 2021. A second analyses compared insulin use for people with diabetes located in 14 states with out-of-pocket caps for at least one full quarter in 2020 or 2021 to people living in states without an out-of-pocket insulin cap. Another analysis compared people living in states with an out-of-pocket cap of $35 or less per month to those residing in states without an insulin cap. Quarterly insulin claims were used to determine insulin use. Out-of-pocket insulin expenses were standardized to a 30-day supply.
Prescription fills unchanged by caps
The study included 2,177 people with type 1 diabetes and 9,046 people with type 2 diabetes using insulin that lived in a state with an out-of-pocket insulin cap in 2020 or 2021, as well as3,593 people with type 1 diabetes and 18,318 people with insulin-treated type 2 diabetes living in states without a cap.
People with type 1 diabetes living in states without an insulin cap had an average of 2.2 prescription fills per quarter in 2018 and 2019 compared with 1.8 prescription fills per quarter for adults with type 1 diabetes living in a state with an insulin out-of-pocket cap in 2020 or 2021. Among adults with type 2 diabetes, those living in states without an insulin out-of-pocket cap filled a mean two prescriptions per quarter in 2018 and 2019 compared with 1.8 prescription fills per quarter in 2020 or 2021 for adults living in a state with an insulin cap.
No change in quarterly insulin claims was observed after Colorado implemented its insulin cap compared with states without a cap. In an analysis of 14 states that instituted insulin out-of-pocket caps in 2020 and 2021, there was no difference in insulin claims after the cap was implemented compared with states without a cap for adults with type 1 and type 2 diabetes. There was also difference in quarterly insulin claims observed when researchers only assessed states with a monthly out-of-pocket cap of $35 or less.
Among adults with type 1 diabetes in 2018 and 2019, 20.9% were spending more than $50 out-of-pocket per month and 62.5% spent more than $25 per month in 2018 and 2019. After caps were implemented in 2020 and 2021, 8.7% of those with type 1 diabetes had more than $50 in out-of-pocket insulin costs and 33.6% had out-of-pocket spending of more than $25.
Of adults with type 2 diabetes, 15.5% had out-of-pocket costs of more than $50 per month in 2018 and 2019, and 52.1% spent more than $25 in monthly insulin out-of-pocket costs. After an out-of-pocket cap was implemented, 7.9% of adults with type 2 diabetes continued to spend more than $50 per month out of pocket for insulin and 38.7% had out-of-pocket spending of more than $25 per month.
Anderson said the findings show out-of-pocket insulin caps may work best for adults who do not have as many financial resources, such as those without health insurance, people with high-deductible commercial insurance and older adults enrolled in Medicare.
“Going forward, it will be important to understand whether insulin out-of-pocket caps help shift patients from lower-cost, less effective products to higher-cost, more effective products,” Anderson said. “It will also be important to study the effects of changes in how manufacturers are pricing insulin products and the use of newer treatments, such as GLP-1 receptor agonists and SGLT2 inhibitors.”
For more information:
Kelly E. Anderson, PhD, can be reached at kelly.e.anderson@cuanschutz.edu.
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