1.3M adults rationed insulin to save money in 2021

An estimated 1.3 million adults with diabetes rationed their insulin to save money in 2021.

Adam Gaffney, MD, MPH

A new study found 16.5% of all adults who use insulin had “skipped insulin doses,” “took less insulin than needed,” or “delayed buying insulin,” due to cost in the past year. The data comes from the 2021 National Health Interview Survey by the U.S. Centers for Disease Control and Prevention (CDC).

That analysis collected health information from 29,482 adults and found about 1.4 million adults with type 1 diabetes (T1D) and 5.8 million adults with type 2 diabetes (T2D), with 400,000 people reporting another or unknown type diabetes using insulin.

In the study, 29.2% of people with no health insurance had the highest rate of rationing, followed by 18.8% of people with private insurance. Patients with public coverage had lower rates, with 13.5% of Medicare insureds rationing their insulin.

“Insulin rationing is frequently harmful, and sometimes deadly,” lead author Adam Gaffney, MD, MPH, said in a news release. Gaffney is a pulmonary and critical care physician at Harvard Medical School and the Cambridge Health Alliance.

“In the ICU I have cared for patients who have life-threatening complications of diabetes because they couldn’t afford this life-saving drug,” Gaffney said. “Universal access to insulin, without cost barriers, is urgently needed.”

Among the findings:

• 18.6% of people with T1D rationed insulin. The authors noted skipping insulin doses can lead to diabetic coma and death for those patients.
• 15.8% of people with T2D rationed insulin.
• People aged 65 years and older, virtually all of them eligible for Medicare, had a lower rationing rate – 11.2% – a than those younger than 65, who reported a rationing rate of 20.4%.
• 19.8% of middle-income insulin users rationed insulin use.
• 10.8% of higher-income insulin users rationed their use.
• 23.3% of Black insulin users rationed their use, compared to 16% of White and Hispanic users.

The researchers examined insulin use, not prices, but noted the findings could influence health care policy decisions that affect finances of patients and pharmaceutical makers. The initial patent for insulin sold for $1, but today insulin prices are greater in the United States than in other countries.

“Drug companies have ramped up prices on insulin year after year, even for products that remain completely unchanged. Drug firms are making vast profits at the expense of the health, and even the lives, of patients,” senior author Dr. Steffie Woolhandler, MD, MPH, said in a news release. Woolhandler is distinguished professor at the City University of New York’s Hunter College, lecturer in medicine at Harvard, and a research associate at Public Citizen.

President Joe Biden’s administration has touted provisions of the 2022 Inflation Reduction Act, capped Medicare enrollees’ copays for insulin at $35 per month.

“The initial draft of that bill would also have capped insulin costs for people with private insurance,” the authors said in a news release. “However, Republicans stripped that provision from the bill after the Senate parliamentarian ruled that it wouldn't comply with the budget reconciliation process that Democrats used to pass the cap. As a result, neither the privately insured nor the uninsured — the groups who the new study found most often rationed insulin — have any protection from insulin costs, which can average $1000 per month or more.”

“Further reform could improve access to insulin for all Americans,” the study said.

The study, “Prevalence and Correlates of Patient Rationing of Insulin in the United States: A National Survey,” was published this month in the Annals of Internal Medicine.