Despite over 20 states having caps on insulin out-of-pocket costs for insured people, researchers have found that such measures do not significantly increase insulin use in Type 1 and Type 2 diabetes patients. This is likely because most patients were already paying lower out-of-pocket costs than the cap amounts, according to a first-of-its-kind study led by researchers from the University of Colorado Anschutz Medical Campus. Approximately a quarter of patients who use insulin report underuse because of cost, they wrote.
Currently the state-led insulin caps are only for people who are have private health insurance. The research team analyzed data from 2018 to 2021, including 33,134 people with Type 1 diabetes or insulin-managed Type 2 diabetes who had private health insurance coverage. Caps ranging from $25 to $100 per month failed to increase insulin use or make it more affordable, as intended, even at the most generous levels.
Historically, the high cost of insulin has been a significant barrier to proper diabetes management. Annual out-of-pocket spending for patients with diabetes was between $2,000 and $3,000 from 2006 to 2017, while insulin list prices, also referred to as the wholesale acquisition cost, tripled between 2007 and 2018. Specifically, the research team calls for out-of-pocket caps that target “financially vulnerable groups,” including seniors who have Medicare, enrollees in state marketplace plans, individuals or families on high deductible health care .