01 Jun Higher Health Care Costs for Children with Diabetes, Mostly Due to Greater Use of Insulin Pump
MedicalResearch.com Interview with:
Kao-Ping Chua, M.D., Ph.D.
Assistant Professor, Pediatrics, Medical School
Susan B. Meister Child Health Evaluation and Research Center
University of Michigan
MedicalResearch.com: What is the background for this study?
Response: Due to high and rising prices, insulin has become increasingly unaffordable for patients with type 1 diabetes who must pay out-of-pocket for this life-saving medication. Over the past 5 months, many states and insurers have taken steps to cap insulin out-of-pocket spending. For example, Cigna imposed a $25 monthly cap earlier this year. This week, the Centers for Medicare and Medicare Services announced a $35 monthly cap for many Medicare Part D beneficiaries.
MedicalResearch.com: What are the main findings?
Response: In this study, we assessed out-of-pocket spending across all health care services among privately insured patients with type 1 diabetes. Using 2018 national commercial claims data, we found that annual overall out-of-pocket spending averaged almost $2,500 per year. Of that total, $435 (18%) was for insulin, compared with $490 for diabetes-related supplies such as insulin pumps, $385 for other type 1 diabetes-related services such as visits to endocrinologists, and $1,103 for other services that weren’t directly related to type 1 diabetes.
We also found substantial variation between children and adults. While mean overall out-of-pocket spending was similar among children and adults, children had higher mean out-of-pocket spending for insulin and almost $300 higher mean out-of-pocket spending for diabetes-related supplies. One of the reasons for the latter finding is that almost 4 in 5 children used an insulin pump, continuous glucose monitor, or both, compared with just over half of adults.
Finally, we found that patients with high-deductible health plans had substantially higher out-of-pocket spending across all categories of health care compared with patients enrolled in other types of plans.
MedicalResearch.com: What should readers take away from your report?
Response: This study shows that even if insulin were free, patients with type 1 diabetes would still have a substantial amount of out-of-pocket spending from other health care. While eliminating cost-sharing for insulin is absolutely the right thing to do, it is also necessary to improve insurance coverage more globally, thereby mitigating financial barriers to accessing other important care such as insulin pumps and continuous glucose monitors. For many patients, these technologies are crucial to achieving diabetes management goals. Young children, for example, often can’t tolerate the multiple needle-sticks that are needed to deliver insulin each day.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We need to obtain real-time data to determine the impacts of the COVID-19 pandemic on access to care among patients with type 1 diabetes. Estimates suggest that millions of Americans have lost their employer-sponsored insurance coverage. For some of these newly uninsured patients, insulin, diabetes-related supplies, and the other care they require may become out of reach.
Even among people who didn’t lose their jobs, income may have dropped due to pay cuts, making health care more difficult to afford.
Chua K, Lee JM, Conti RM. Out-of-Pocket Spending for Insulin, Diabetes-Related Supplies, and Other Health Care Services Among Privately Insured US Patients With Type 1 Diabetes. JAMA Intern Med. Published online June 01, 2020. doi:10.1001/jamainternmed.2020.1308
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