01 Jun Trends in Out-of-Pocket Costs for Insulin

MedicalResearch.com Interview with:

Dr. Meiri

Amir Meiri, MD MPH
Atrius Health/Department of Population Medicine (DPM) | Delivery System Science Fellow
HMS and HPHCI, DPM | General Internal Medicine Fellow
Atrius Health Kenmore | Urgent Care Physician
VA Boston Healthcare | Attending in Internal Medicine and Emergency Medicine 

MedicalResearch.com: What is the background for this study?

Response: There has been significant media reporting about rising insulin prices and the health impacts of those exorbitant prices. However, it was not clear how these insulin prices may impact out-of-pocket costs among commercially insured patients; though it is clear that those without insurance are affected per previous media reports. Our study examines the difference between insulin manufacturer-set prices and what patients actually pay, the out-of-pocket cost, in the context of the type of insurance patients have.

MedicalResearch.com: What are the main findings?

Response: Our major findings showed that insulin out-of-pocket costs are generally lower than expected, except among patients in high-deductible health plans with health savings accounts (HDHP-HSA), who must pay for the full cost of medications (including insulin) until they reach their deductible and are declining. Among all insulin users, out-of-pocket costs per month peaked at $72 in 2013, then decreased to $64 by 2017. HDHP-HSA members’ insulin out-of-pocket costs per month peaked at $150 in 2014, then decreased to $141 by 2017. While insulin reimbursement price increased, the share that patients paid actually decreased substantially over time.

MedicalResearch.com: What should readers take away from your report?

Response: Surprisingly, we found that very high out-of-pocket insulin costs might not be typical for commercially insured patients, except among HDHP-HSA members. Furthermore, insulin out-of-pocket costs have been declining. Importantly, we also found that health insurers are absorbing most of the price of insulin, but this likely contributes to rising health insurance premiums, a burden that affects all of us but especially the poor.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future research must rigorously evaluate the financial and health impacts of recent state and federal policies that cap monthly out-of-pocket costs for insulin. It will be essential to understand which subpopulations (such as by illness severity or sociodemographic factors) are impacted the most, which will inform more targeted approaches to future similar policies.

Additionally, we recommend examining if high insulin prices translate into high out-of-pocket costs that affect insulin utilization among the most vulnerable population, low-income patients in high-deductible health plans with health savings accounts. If so, this could help inform more tailored future policies aimed to reduce the cost burden of insulin among patients. 

MedicalResearch.com: Is there anything else you would like to add?

Response: The discrepancy in price and out-of-pocket cost for insulin highlights the root of the problem: high insulin prices are set by manufacturers. These exorbitant prices must be lowered through policy regulation or competition, which does not exist due to the lack of price and out-of-pocket cost transparency in the US market. Without addressing the problem of high insulin prices, this financial burden will ultimately be passed on to all health insurance beneficiaries through higher premiums.

No disclosures. 

Citation:

Meiri A, Zhang F, Ross-Degnan D, Wharam JF. Trends in Insulin Out-of-Pocket Costs and Reimbursement Price Among US Patients With Private Health Insurance, 2006-2017. JAMA Intern Med. Published online June 01, 2020. doi:10.1001/jamainternmed.2020.1302

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Last Updated on June 1, 2020 by Marie Benz MD FAAD