One out of every seven people in the United States who filled an insulin prescription in 2017 and 2018 spent more than 40 percent of their post-subsistence family income — defined as a "catastrophic spending" level — on insulin.
A report published in the July issue of Health Affairs by Yale University researchers indicates that 14.1% of Americans (representing 1.2 million people) who use insulin reached those high spending levels over the course of one year.
"Nearly two-thirds of patients who experienced catastrophic spending on insulin were Medicare beneficiaries," the report notes. "Catastrophic spending was 61 percent less likely among Medicaid beneficiaries than among Medicare beneficiaries, suggesting that factors other than income, such as different types of insurance coverage, may influence catastrophic insulin spending."
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The likelihood of reaching catastrophic spending levels was linked to family income, according to the report, with an annual income greater than $44,000 "essentially shielding people entirely from catastrophic spending."
Catastrophic spending was least common among patients covered by private insurance, yet those patients also had the highest levels of out-of-pocket spending on insulin of any group other than the 100 percent self-pay group.
"This study helps point to areas in greatest need of policy changes targeting insulin affordability and accessibility in the U.S.," wrote report authors Baylee F. Bakkila and Kasia J. Lipska. "Older people with low family incomes appear to be at the greatest risk for high out-of-pocket spending relative to their available resources."
The report also suggests policy reform is needed regarding insulin affordability and accessibility.
"High insulin prices, inadequate coverage by insurance providers, and low family incomes have led many in the U.S. to experience catastrophic health spending on insulin," the authors conclude. "Drug manufacturers and policymakers must work to make this essential medication more affordable for those who need it."
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