High Costs Drive 1 in 4 Patients With Diabetes to Use Too Little Insulin

Despite the fact that the World Health Organization classifies insulin as an essential medicine that should be available at all times at a price that patients can afford, US insulin prices have continued to climb in recent years. High costs are linked with nonadherence, and a recent study published in JAMA Internal Medicine sought to better understand the prevalence of cost-related insulin underuse.¹

A research team from the Yale Diabetes Center surveyed 199 patients with type 1 and type 2 diabetes who had been prescribed insulin in the prior 6 months. The study’s primary outcome was cost-related insulin underuse in the prior 12 months. They also studied the association between cost-related underuse and poor glycemic control.

Among the respondents, 25.5% reported that they had underused insulin because of cost. The type of prescription drug benefit that the patients had did not have a significant association with underuse, but patients who underused insulin were more likely to have lower incomes. In total, 60.8% of those who used too little insulin discussed cost with their providers, and 29.4% changed their type of insulin to be better able to afford their medication. Patients who reported cost-related underuse were more likely to have poor glycemic control (odds ratio, 2.96; 95% CI, 1.14-8.16; P = .03).

“Regulators and the medical community need to intervene to ensure that insulin is affordable to patients who need it. At minimum, individual clinicians should screen all patients for cost issues to help them address these challenges,” wrote the investigators of these findings.

In an accompanying commentary, Elisabeth Rosenthal, MD, pointed out that the average wholesale price of 4 of the top-selling insulin products nearly tripled between 2007 and 2017.²

“As drug costs have generally increased in the United States, we know that many patients are skimping on medicines, taking less than prescribed, and cutting pills in half to make every fill last longer…skimping on insulin can be rapidly deadly in people whose bodies make none of their own and can result in a life-threatening metabolic disturbance,” she wrote.

Rosenthal highlighted cases in which some patients with diabetes have taken such extreme measures as moving out of the United States to be able to pay for their life-sustaining therapy. “But others—that 25%—will quietly skimp on their insulin,” she concluded, “taking less than they need but more, perhaps, than they can really afford. Some of them will die.”

References

1. Hekert D, Vijayakumar P, Luo J, et al. Cost-related insulin underuse among patients with diabetes [published online December 3, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.5008.

2. Rosenthal E. When high prices mean needless death [published online December 3, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.5007.