Insulin Out-of-Pocket Cost Caps Do Not Increase Insulin Use

(HealthDay News) — Insulin out-of-pocket (OOP) cost caps are associated with a reduction in insulin OOP costs, but no increase in insulin use, according to a study published online March 26 in the Annals of Internal Medicine.

Laura F. Garabedian, Ph.D., M.P.H., from Harvard Medical School and the Harvard Pilgrim Health Care Institute in Boston, and colleagues conducted a pre-post study with a control group to examine the effect of state insulin OOP caps on insulin use and OOP costs among patients with diabetes. Data were included from eight states implementing insulin OOP caps of $25 to $30, $50, or $100 in January 2021 and 17 control states.

The researchers found that in the overall population, state insulin caps were not associated with changes in insulin use (relative change in fills per month, 1.8 percent). In intervention states, insulin users had a 17.4 percent relative reduction in insulin OOP costs, which was mainly driven by reductions among health savings account (HSA) enrollees; among nonaccount plan members, there were no differences seen in OOP costs. Insulin OOP cost reductions were larger (40.0 percent) in association with more generous ($25 to $30) state insulin OOP caps, which was mainly driven by larger reductions in those with HSA plans.

“Other policies might be needed to improve access to affordable insulin among commercially insured patients with diabetes who have cost-related underuse,” the authors write.

Rising insulin costs

In recent years, the rising costs of insulin have become a critical issue affecting millions of Americans, particularly those with diabetes. However, the burden of these rising costs is not distributed evenly across all demographics. The Black community, already facing significant health disparities, bears a disproportionate share of the impact.

According to the Centers for Disease Control and Prevention (CDC), Black Americans are more likely to develop type 2 diabetes and experience complications such as kidney failure, amputations, and blindness. Additionally, they are nearly twice as likely to die from diabetes-related causes compared to their white counterparts. These disparities stem from various factors, including socioeconomic status, access to healthcare, and systemic racism within the healthcare system.

Insulin costs and the Black community

The burden of rising insulin costs falls heavily on the Black community, amplifying existing health disparities and economic challenges. Black Americans are more likely to be uninsured or underinsured compared to white Americans, limiting their access to affordable healthcare services and medications like insulin. Without adequate insurance coverage, many individuals struggle to afford the high out-of-pocket costs associated with insulin prescriptions.

Also, systemic racism within the healthcare system further exacerbates disparities in access to affordable insulin. Studies have shown that Black patients are less likely to receive quality diabetes care, including access to insulin pumps and continuous glucose monitors, which can improve diabetes management and reduce the need for insulin injections.

To address the crisis of rising insulin costs requires full-spectrum strategies aimed at reducing health care disparities and improving access to affordable medications for everyone, regardless of race or socioeconomic status. Increasing access to affordable health insurance coverage, particularly for low-income individuals and communities of color, through initiatives such as Medicaid expansion and subsidies for health insurance premiums can aid in insulin affordability. Community-based programs and resources to provide assistance with medication costs, diabetes management education, and support services for individuals with diabetes in underserved communities are also helpful.

The rising costs of insulin is a significant threat to the health and well-being of Black Americans. Addressing this crisis requires a solid approach that tackles underlying factors such as economic inequality, limited access to health care, and systemic racism within the health are system. By implementing policies to improve affordability and access to insulin, we can lessen the disproportionate impact of rising insulin costs on the Black community and ensure equitable health outcomes for those with diabetes.

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