The cost of insulin for Americans with diabetes has more than tripled in a decade, according to a new research paper published in JAMA.
Image credit: Xinyang Hua et al.
Insulin costs have risen sharply, while the costs of other medications to control blood sugar have not, say researchers from the University of Michigan in Ann Arbor and the University of Melbourne in Australia.
They say both the yearly spending by people with diabetes and the cost per ml of insulin have shot up, outpacing costs of other glucose-control medications.
Moreover, the rise has been so steep that, since 2010, the per-person spend on insulin is more than the per-person spend on all other diabetes drugs combined.
In their paper, the authors show that the per-patient cost of insulin rose from $231 a year in 2002 to $736 a year in 2013, while the cost per ml of insulin rose from $4.34 to $12.92. The values are standardized to the 2013 dollar.
Over the same period, the average amount of insulin a patient used per year rose from 171 ml to 206 ml, as doctors prescribed higher doses. The authors suggest two reasons for this: one is the increase in overweight and obese patients, and the other is changes in national recommendations toward more aggressive treatment for high blood sugar.
For all other medications for lowering blood sugar, the spend fell from about $600 in 2002 to $502 in 2013.
The authors also note the price of insulin is unlikely to fall in response to competition from generic versions because of the way it is regulated.
For their analysis, the team used 2002-2013 figures about health care and costs that patients and insurers give in response to the federal Medical Expenditure Panel Survey.
The data covered nearly 28,000 people of an average age of 60 who received treatments for diabetes over the 11-year period, when diabetes was rising steadily.
The researchers estimated what patients and their insurance plans paid from 2002-2013 for all medicines that reduce blood sugar levels (antihyperglycemics). They express the costs in terms of 2013 dollar values.
Coauthor Dr. William Herman, a professor of internal medicine at the Medical School and of epidemiology in the School of Public Health at Michigan, has been researching diabetes care for a long time.
He says the more than three-fold increase in insulin cost is “alarming” and questions the point of bringing out better, more expensive versions if it means some patients are denied access to lifesaving treatment. He notes:
“Although the newer, more expensive insulin analogs appear to have incremental benefits compared to older, less expensive insulin preparations, their premium price requires us to ask whether they are really necessary, and if so, for whom?”
The authors suggest it is time to take another look at the effectiveness and cost-effectiveness of non-insulin treatments for diabetes.
Senior author Philip Clarke, a professor in Melbourne’s School of Population and Global Health and Centre for Health Policy, says:
“What our study shows is how quickly things can change and why there is a need to focus on the costs as well as the benefits when deciding treatment options for people with diabetes.”
Diabetes is a disease where the body either cannot produce or use insulin – a hormone that converts glucose or sugar from food into energy for cells. Untreated, diabetes results in high levels of glucose in the blood, which eventually causes serious damage to organs, including the eyes and the kidneys.
There are two main types of diabetes. Type 1 usually begins in childhood and arises when the immune system destroys insulin-producing cells in the pancreas.
Type 2 diabetes – which accounts for 95% of diabetes – occurs when the body cannot use insulin properly. The pancreas responds by making more and more of it, but eventually it is not enough and glucose levels rise.
People with type 1 diabetes require insulin; people with type 2 diabetes can take oral medication, but may also require insulin.
Around a quarter of the participants in the survey the researchers analyzed were controlling blood sugar with insulin, while two thirds were using an oral drug. However, there was a small shift toward taking new injectable drugs designed to complement oral drug use in the latter part of the study period.
The authors note they could not distinguish between use of the less costly, older, synthetic human insulin and the newer “analogs” that act more slowly or quickly, depending on the treatment required.
Also, the findings do not cover other costs associated with taking diabetes medication, such as cost of needles and other devices used to inject insulin, except when it was included in the cost of the drug, such as for pre-filled insulin pens.
The authors say that form of the data also did not allow for them to determine which participants took generic forms of diabetes drugs. They note, however, that while oral medications are likely to become cheaper as more generic forms enter the market, insulin prices are unlikely to be affected by generics because it is a biologic drug that is regulated by much stricter rules in the US.
There has been some criticism of the findings. For example, UPI report that one of the insulin manufacturers, Eli Lilly, said in a statement that the “list” price of insulin is not what the manufacturer receives but a “starting point for negotiations with payers, wholesalers, and others involved in the distribution process.”
In the meantime, researchers are working on ways to improve treatments for diabetes so patients can get away from daily injections of insulin. Earlier this year, Medical News Today learned that encapsulated pancreatic cells may one day offer an alternative to insulin injection.