A Closer Look at the Increasing Cost of Insulin

Anne M. Schwartz, Pharm.D., Avera Marshall Regional Medical Center

Background: The increasing cost of insulin has been a heavily debated topic in recent news. For patients with Type I Diabetes, insulin is a necessary medication for survival. First-hand stories of patients putting their lives in danger by rationing their insulin supply to cut down on costs or paying hundreds of dollars a month for their insulin to stay alive have riddled social media outlets. Many organizations have taken the initiative to research this issue and brainstorm ways to make insulin more affordable.

Evidence: Earlier this year, the Health Care Cost Institute (HCCI) published a brief entitled “Spending on Individuals with Type 1 Diabetes and the Role of Rapidly Increasing Insulin Prices”. They collected data on patients with Type 1 Diabetes by using health care claims between 2012 and 2016 and investigated trends in total health care spending. HCCI found that gross spending on insulin for these individuals doubled from 2012 to 2016. They were able to rule out increase in cost due to increase in insulin usage by calculating only a three percent increase in average daily insulin use by these individuals. While they did attribute a slight increase in spending to the transition to newer, more expensive alternatives (e.g. pre-filled insulin pens versus vial and syringe and using newer brands such as Tresiba and Toujeo), they credited the majority of the increase in spending to the rapidly increasing insulin prices. Because use of manufacturer coupons and rebates is not available to the public, HCCI was not able to evaluate their potential effect on gross insulin spending during this investigation. 

Another perspective comes from Douglas Holtz-Eakin, President of the American Action Forum, who released a testimony earlier this year regarding his opinion on drug pricing in America. In his testimony to the United States Senate Committee on Finance, Mr. Holtz-Eakin stated that overall out-of-pocket (OOP) costs for prescription medications has declined since 2013. While the majority of prescription medications had an OOP cost of less than $50 in 2017, 0.1% of prescription medications had an OOP cost of more than $500, with an average OOP cost of $1,502 per prescription. These increased prescription medication costs likely belonged to specialty medications, including insulin. Mr. Holtz-Eakin did not discount the fact that specialty medications cost more to manufacture, and encouraged people to remember that the goal of specialty medications is not low cost, but instead high value. Mr. Holtz-Eakin related the increase in drug prices to increased government regulations and taxes. In fact, his proposal to combat these increased prices includes greater competition within classes of high-cost medications and greater financial incentives for payers and manufacturers to increase supply. 

Discussion and Clinical Impact: While varying opinions exist on this matter, the data on rapidly increasing insulin prices released by HCCI is alarming. Patients cannot afford to have life-saving medications double in price every four years. Educating yourself on the current healthcare legislature and voting on these important topics remains a crucial component in caring for patients. Pharmacists can also play an important role in helping patients find the most cost effective medication while considering insurance coverage and availability of manufacturer rebates or coupons. Educating patients to talk with their pharmacist regarding prescription drug costs may help alleviate some of their financial burden. 

References:

  1. Fuglesten Biniek J, Johnson W. Health Care Cost Institute. Spending on Individuals with Type 1 Diabetes and the Role of Rapidly Increasing Insulin Prices. https://www.healthcostinstitute.org/research/publications/entry/spending-on-individuals-with-type-1-diabetes-and-the-role-of-rapidly-increasing-insulin-prices. Published January 2019. Accessed May 2019.

  2. Holtz-Eakin D. American Action Forum. Testimony Regarding: Drug Pricing in America: A Prescription for Change, Part I. https://www.americanactionforum.org/testimony/testimony-regarding-drug-pricing-in-america-a-prescription-for-change-part-i/. Published January 29, 2019. Accessed May 2019.