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

Health Aff (Millwood). 2024 Aug;43(8):1137-1146. doi: 10.1377/hlthaff.2024.00118.

Abstract

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.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • 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
  • Female
  • Health Expenditures* / statistics & numerical data
  • Humans
  • Hypoglycemic Agents* / economics
  • Hypoglycemic Agents* / therapeutic use
  • Insulin* / economics
  • Insulin* / therapeutic use
  • Insurance Claim Review
  • Insurance Coverage / statistics & numerical data
  • Insurance, Health / economics
  • Insurance, Health / statistics & numerical data
  • Male
  • Middle Aged
  • United States
  • Young Adult

Substances

  • Insulin
  • Hypoglycemic Agents