More than 1.3 million American adults with diabetes skipped doses, delayed buying or otherwise rationed doses of insulin due to escalating cost of the life-saving medication, a new study found.
A study published Monday in the Annals of Internal Medicine estimated 16.5% of adults with diabetes who are dependent on insulin did not take full doses as prescribed due to the affordability of the drug.
The study, led by researchers at Harvard Medical School, City University of New York’s Hunter College, and the nonprofit consumer advocacy organization Public Citizen, provides a national snapshot on the number of Americans who struggle to afford a drug they can’t live without.
All people with Type 1 and some with Type 2 diabetes need the drug, but the price of versions of the drug nearly tripled from 2002 to 2013, according to one study.
Dr. Steffie Woolhandler, a study author and professor at the City University of New York’s Hunter College, said the escalating cost of a century-old drug, albeit with new formulations, is jeopardizing the health of too many Americans.
“This is very, very worrisome to doctors,” said Woolhandler, also a lecturer in medicine at Harvard and a research associate at Public Citizen. “If people have poorly controlled diabetes … they end up with lots of complications and earlier death.”
The study analyzed data from the 2021 National Health Interview Survey. The survey asked adult insulin users whether in the past year they skipped doses, took less insulin than needed or delayed buying insulin to save money. If anyone answered yes on any of those three questions researchers considered them to be rationing doses.
The study reveals insulin rationing varies based on age, income and race. About 11% of Medicare-age adults 65 and older rationed insulin compared to more than 20% of younger adults.
Under the sweeping climate and health bill called the Inflation Reduction Act, more than 3 million Medicare recipients who take insulin will get some financial relief. Beginning next year, Medicare recipients will see insulin prices capped at $35 a month under the federal law. That cap will not extend to younger Americans who are more likely to ration insulin.
Nearly 20% of middle-income earners rationed insulin, nearly double the rate of higher-income individuals; less than 15% of low-income people rationed insulin.
Researchers said one explanation is middle-income families don’t qualify for Medicaid, the government’s health insurance program for low income and disabled families. Middle-class families are more likely to have private health insurance coverage that requires higher out-of-pocket costs with deductibles, copayments and coinsurance.
The study also found rationing was higher among Black individuals compared to white and Hispanic persons.
“The fact of the matter is that insulin is far more expensive in the United States than in other countries,” said Dr. Adam Gaffney, the study’s lead author, a Harvard Medical School pulmonary and critical care physician. “To further compound the problem, we have a particularly fragmented health insurance system.”
The American Diabetes Association has pushed legislative efforts to make insulin affordable for all Americans. A bill introduced in June by Sen. Jeanne Shaheen, D-New Hampshire, and Susan Collins, R-Maine, aims to lower list prices and limit out-of-pocket costs for patients.
Senate Democrats attempted to extend Medicare’s monthly price cap for insulin to private insurance as part of health and climate bill. However, the
Senate parliamentarian decided the cap on private insurers was not in line with the rules of reconciliation.
Lisa Murdock, chief advocacy officer of the American Diabetes Association, said her organization will continue to push to make the drug more affordable for all people.
“We don’t want people to have to jump through extra hoops to get access to a medication that they literally have to have in order to live,” said Murdock.