Exacerbation of financial burden of insulin and overall glucose‐lowing medications among uninsured population with diabetes

Approximately 7.4 million Americans with diabetes used insulin. This study aimed to document the 10-year trend of insulin and other glucose-lowering medications expenditure among insured and uninsured populations and to examine the impact of insulin out-of-pocket (OOP) payment and insurance status on glucose-lowering medication OOP expenditure.We extracted data from the Medical Expenditure Panel Survey (2009-2018) to document trends in the expenditure of insulin among people with diabetes. Total expenditures and OOP spending per person were documented on insulin and noninsulin glucose-lowering medications among insured and uninsured populations. Multivariable regression was applied to assess the association of insulin OOP payment and insurance status on glucose-lowering medication OOP expenditure.Although insulin usage was stable over the decades, total insulin expenditure almost doubled per person per year after the Affordable Care Act (ACA) regardless of the insurance status. The OOP cost of insulin by the uninsured population increased from $1678 per person per year in the pre-ACA period to $2800 per person per year in the post-ACA period. After the ACA was enacted, the uninsured population had $403.96 and $143.64 more on OOP costs than the people with public and private insurance, respectively.For insured people, the rising financial burden of insulin was borne mainly by insurance. The uninsured population is bearing a heavy burden due to the high price of insulin. Policymakers should take action to reduce the insulin price and improve the transparency of the insulin pricing process.