More Data Indicate Dramatic Increase in Insulin Price and Use

Veronica Hackethal, MD

April 08, 2016

A new study suggests that the price of insulin in the United States increased dramatically from 2002 to 2013, compared with oral antihyperglycemics.

The research is the first to report trends in expenditures for different classes of antihyperglycemic medications that simultaneously consider changes in use and price, say the authors, who published their findings in the April 5 issue of the Journal of the American Medical Association.

"Based on a nationally representative survey, the mean price of insulin increased from $4.34/mL in 2002 to $12.92 in 2013. The estimated expenditure per patient for insulin in the United States in 2013 was greater than all other antihyperglycemic medications combined," writes Philip Clarke, PhD, of the University of Melbourne, Victoria, Australia, along with colleagues at the University of Chicago and the University of Michigan.

"Significant changes in mean price of insulin, relative to comparator therapies, suggest a need to reassess the effectiveness and cost-effectiveness of alternative antihyperglycemic therapies," they point out.

While people with type 2 diabetes may have some choice on whether or not to use insulin, those with type 1 diabetes, who require insulin, have fewer choices.

First to Report Trends in Expenditures for Different Diabetes Meds

The researchers evaluated individual and prescription-level data from 27,878 people treated for diabetes (mean age, 60.4 years; 44.4% men) in the nationally representative Medical Expenditure and Panel Survey (MEPS) from 2002 to 2013. They identified medications using class codes, obtained information on drug expenditures and quantity from household surveys verified by pharmacies, and adjusted costs for inflation.

Results showed that the prevalence of treated diabetes increased from 5.2% in 2002–2004 to 7.7% in 2011–2013 and estimated spending for insulin per patient increased even more strikingly, more than tripling from $231.48 in 2002 to $736.09 in 2013.

And while the average price/mL of insulin skyrocketed by 197% between 2002 and 2013, in contrast, the mean price of dipeptidyl peptidase-4 (DPP-4) inhibitors increased by only 34%, from $6.67 per tablet in 2006 to $8.92 in 2013. And the average price of metformin actually decreased by 93%, from $1.24 per tablet in 2002 to $0.31 per tablet in 2013.

In 2013, analog insulin cost about $507.89 per patient, while human insulin cost about $228.20 per patient.

The authors point out that increased treatment intensity may have contributed to the rising costs, as the amount of insulin used also increased from 171 mL in 2002–2004 to 206 mL in 2011–2013.

The study could not evaluate the cost of insulin delivery devices, except prefilled pens. In addition, a change in editing rules for MEPS-prescribed medications could have overestimated drug expenditures by 10%.

Not the First Research to Pinpoint this Problem

This new study is the latest in a long line of work highlighting this issue.

Other recent research has shown that Medicaid payments for insulin have skyrocketed over the past 25 years. Although newer, patented insulin analogs account for much of the increase in costs, the price of older insulin products has also risen.

The root cause may be lack of price competition for insulin products and lack of generic insulins available in the United States.

Some experts have also questioned whether the advantages of newer insulin analogs — slightly less nocturnal hypoglycemia and more flexible dosing — are enough to merit their higher costs for some patients, for whom less expensive human insulin may be appropriate.

And the problem extends globally — governments have a wide range of prices at which they reimburse for insulin, and just three companies dominate the worldwide insulin market. That means patients sometimes have to change insulin types when one supplier withdraws formulations or increases the price.

Regulatory issues surrounding biosimilars have also led to limited availability of lower-cost alternatives. Shifting from vials to more expensive patented pen devices has also increased costs.

All of this has led doctors to issue a call for action to improve global access to insulin.

Dr Clarke reports no relevant financial relationships. Disclosures for the coauthors are listed in the article.

JAMA. 2016;315:1400-1402. Abstract

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