State Out-Of-Pocket Caps On Insulin Costs: No Significant Increase In Claims Or Utilization

• Published in: Health affairs (Millwood, Va.) Vol. 43; no. 8; pp. 1137 - 21
• Main Authors: Anderson, Kelly E, Chaiyakunapruk, Nathorn, Gutierrez, Eric J, Schmutz, H Weston, Rose, Michael R, Brixner, Diana, McQueen, R Brett
• Format: Journal Article
• Language: English
• Published: United States The People to People Health Foundation, Inc., Project HOPE 01.08.2024
• Subjects: Adolescent; Adult; Claims; Costs; Diabetes; Diabetes mellitus (insulin dependent); Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - economics; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - economics; Drug Costs - statistics & numerical data; ERISA; Expenditures; Female; Glycemic control; Health care expenditures; Health care policy; Health Expenditures - statistics & numerical data; Humans; Hypoglycemic Agents - economics; Hypoglycemic Agents - therapeutic use; Insulin; Insulin - economics; Insulin - therapeutic use; Insurance Claim Review; Insurance coverage; Insurance Coverage - statistics & numerical data; Insurance, Health - economics; Insurance, Health - statistics & numerical data; Male; Middle Aged; Patients; Personal expenditure; Sociodemographics; Type 1 diabetes mellitus; Type 2 diabetes mellitus; United States; Young Adult; United States; United States > US; Colorado
• ISSN: 0278-2715; 2694-233X; 2694-233X; 1544-5208
• DOI: 10.1377/hlthaff.2024.00118

Nearly all patients with type 1 diabetes and 20-30 percent of patients with type 2 diabetes use insulin to manage glycemic control. Approximately one-quarter of patients who use insulin report underuse because of cost. In response, more than twenty states have implemented monthly caps on insulin out-of-pocket spending, ranging from $25 to $100. Using a difference-in-differences approach, this study evaluated whether state-level caps on insulin out-of-pocket spending change insulin usage among commercially insured enrollees. The study included 33,134 people ages 18-64 who had type 1 diabetes or who used insulin to manage type 2 diabetes with commercial insurance coverage that was subject to state-level oversight and was included in the 25 percent sample of the IQVIA PharMetrics database during 2018-21. Insulin out-of-pocket caps did not significantly increase quarterly insulin claims for enrollees who had type 1 diabetes or who used insulin to manage type 2 diabetes. State-level caps on insulin out-of-pocket spending for commercial enrollees did not significantly increase insulin use; that may be in part because of out-of-pocket expenses being lower than cap amounts.