Many adults with diabetes ration insulin, study finds


The cost of insulin remains a barrier for many Americans with diabetes who rely on the drug, research published Monday suggests.

A study in the Annals of Internal Medicine found that in 2021, nearly 1 in 5 US adults with diabetes skipped, delayed, or used less insulin than necessary to save money. That comes to about 1.3 million adults, or 16.5% of those who need insulin.

The findings were based on data from the 2021 National Health Interview Survey, conducted annually by the Centers for Disease Control and Prevention, which interviews tens of thousands of Americans about their health-related experiences.

It was the first time the CDC had included questions about insulin use, though concerns about skyrocketing insulin prices have been reported for years.

“In the ICU, I’ve cared for patients who have life-threatening complications of diabetes because they couldn’t afford this life-saving medication,” said study lead author Dr. Adam Gaffney, an intensive care physician at CambridgeHealth. Alliance in Massachusetts.

“Universal access to insulin, without cost barriers, is urgently needed,” he said.

Starting January 1, the Reducing Inflation Act, signed into law by President Joe Biden in August, will cap the monthly cost of insulin at $35 for seniors with Medicare. However, the bill will leave out millions of Americans with private health insurance, as well as those without insurance.

Those two groups reported the highest rates of insulin rationing, according to the new study. Meanwhile, those with public health coverage, such as Medicaid and Medicare, had the lowest rates of rationing.

According to the research, insulin rationing was found to be more common among black Americans, at 23.2%, compared to white and Hispanic Americans, at 16%.

It was also found to be more common among people with type 1 diabetes, at 18.6%, compared to people with type 2 diabetes, at 15.8%, a finding that Gaffney said was particularly alarming, because People with type 1 diabetes who don’t take their insulin as prescribed can suffer multiple long-term health problems, including diabetic coma or death.

Reduce the cost of insulin

Gaffney said the problem is simply that the list price of insulin is too high.

“We have allowed the pharmaceutical companies to set the agenda, and that comes at a cost to our patients,” he said.

Eric Tichy, who tracks insulin costs as president of the pharmaceutical supply solutions division at the Mayo Clinic in Rochester, Minn., said a handful of drugmakers — Eli Lilly, Novo Nordisk and Sanofi — dominate the US insulin market without generic competition, he said, they are able to keep prices high.

Also, insulin products aren’t necessarily interchangeable, Tichy said, so if a patient is taking, say, an Eli Lilly product, they may not be able to easily switch to the Sanofi product.

As it stands, the government has limited ability to control drug costs, experts say.

The US needs additional policies that “improve the affordability of insulin for those who may have inadequate insurance coverage or no coverage at all,” said Juliette Cubanski, deputy director of the Medicare policy program at KFF, formerly known as the Kaiser Family Foundation. .

One approach is for states and other entities to manufacture their own insulin, as California has announced plans to do.

Tichy is a member of the nonprofit drugmaker Civica Rx, which announced in March that it planned to manufacture and sell generic versions of insulin to consumers for no more than $30 per vial and no more than $55 for a box of five pen cartridges. .

According to the American Diabetes Association, people with type 1 diabetes need, on average, two to three vials per month. For the uninsured and underinsured, a month’s worth of insulin can cost, on average, $1,000 or more, Gaffney said.

Lawmakers can create policies that target “permanence,” a process in which drug companies make incremental improvements to their products that can extend the life of their patents, Cubanski said.

Gaffney advocated for policy changes that would lower the list price of insulin.

He said the “most ambitious” proposal he would like to see in the US is universal health coverage with no copays for consumers. He, too, would like to see a policy that would allow the US to pay the same lower prices other nations pay for insulin.

“I think we can do something like that in the United States,” he said. “That’s obviously a big project, but at the same time we need to lower the prices that pharmaceutical companies charge.”

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