Out-of-Pocket Insulin Costs Stagnant for Commercial Members

Although insulin prices more than doubled between 2006 and 2017, out-of-pocket insulin costs for commercial plan members remained fairly steady over the course of that period, even declining slightly after 2013, according to a recent study published on JAMA Internal Medicine.

“Although the findings in this study contradict the view that insulin cost-sharing is excessive for many privately insured patients, monthly out-of-pocket payments may be burdensome for low-income individuals,” the researchers noted.

“Nevertheless, the data suggest that privately insured patients have been relatively shielded from insulin price increases and that commercial health insurers have accommodated higher insulin prices by increasing premiums or deductibles for all members.”

Relying on Optum data, the study found that median insulin 30-day fill reimbursement price rose 2.75 times the 2006 price until 2017, from $143 in 2006 to $394 in 2017. This constituted a rise of $23 per year.

Despite the fact that the price increased so dramatically, patients did not pay more and, in fact, the price declined starting in 2013. The mean for out-of-pocket healthcare spending on a 30-day insulin refill was $36 in 2006. Prices then spiked $9 to hit $45 over the course of six years. But by 2017 it had nearly returned to 2006 levels, settling down to $38.

Given the increase in insulin costs for private health plans, patient shares of the insulin reimbursement price fell 14 percentage points over the 11-year period from 24 percent in 2006 to 10 percent in 2017.

About 80 percent of study participants were in commercial health plans, so the study largely focused on this population. However, a fraction of data did shed some light on potential insulin cost trends for high deductible health plan health savings account patients.

Almost 775,000 of the individuals studied were in a high deductible health plan health savings account. This comprised around seven percent of the total patient population observed.

The study discovered that patients in these plans saw a good deal of fluctuation over the course of the 11-year timeframe. Costs never dipped anywhere close to private health plan out-of-pocket healthcare spending costs, however, starting at $93 in 2006, jumping to $150 in 2014, and settling down to $141 in 2017.

Thus, while the private health plan members out-of-pocket healthcare spending median was around $38 for a 30-day insulin fill reimbursement in 2017, the out-of-pocket healthcare spending level for those in a high deductible health plan health savings account was approximately $103 higher.

Overall, insulin out-of-pocket healthcare spending per member per month started at $52 in 2006, rose $20 in 2013 but then dropped $8 to hit $64 per member per month at the end of the study.

The study did not attribute any manufacturer rebates for the insulin price, the researchers mentioned as one of the study’s limitations.

The study is limited to insulin costs and does not factor in overall healthcare costs of diabetes. A separate study in 2019 found that between 2012 and 2016, insulin prices pushed annual healthcare spending for patients with Type 1 diabetes from $12,467 to $18,494 in just four years.

Health plans have pursued multiple strategies in attempts to bring down healthcare spending for members.

In 2019, UPMC used a diabetes wellness program to try to decrease healthcare spending for Medicare Advantage patients with diabetes.

Blue Cross and Blue Shield of Minnesota reduced insulin costs to $0 for their commercial, fully insured members.

However, these and other examples reinforce the possible trend of lower out-of-pocket healthcare spending for commercially insured patients with diabetes, as opposed to patients with high deductible health plan health savings accounts.