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Cost-Sharing Caps for Insulin Would Benefit Youth With T1D

WEDNESDAY, July 29, 2020 -- For privately insured young children and adults with type 1 diabetes, the mean annual out-of-pocket spending on insulin was $494 in 2018, and many would benefit from price caps, according to a research letter published online July 27 in JAMA Pediatrics.

Kao-Ping Chua, M.D., Ph.D., from the University of Michigan Medical School in Ann Arbor, and colleagues estimated the potential change in insulin out-of-pocket spending among privately insured children and young adults with type 1 diabetes with implementation of national caps of $25 and $100 for a 30-day insulin supply. Data were obtained for 12,185 persons with continuous enrollment in 2018 with one or more insulin claims in 2018. Of these, 17.1, 41.5, and 41.4 percent were aged 1 to 11, 12 to 17, and 18 to 21 years, respectively; 25.6 percent were high-deductible health plan enrollees.

The researchers found mean annual out-of-pocket spending was $494. For 12.6 percent of patients, annual out-of-pocket spending exceeded $1,000 and included copays, deductibles, and coinsurance (61.3, 15.6, and 23.1 percent, respectively). Overall, 59.9 percent of patents would benefit from a $25 cap on a 30-day insulin supply, with a decrease in spending from $741 to $251. A total of 17.7 percent of patients would benefit from a $100 cap, with a decrease in annual out-of-pocket spending from $1,343 to $786.

"Additional policies are needed to alleviate the financial burden among patients with type 1 diabetes," the authors write.

One author disclosed financial ties to the biopharmaceutical industry.

Abstract/Full Text

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Posted: July 2020