Potential Change in Insulin Out-of-Pocket Spending Under Cost-Sharing Caps Among Pediatric Patients With Type 1 Diabetes

In this paper, we asked the following question: if the federal government enacted a national cap on insulin cost-sharing for privately insured patients, how much money would the families of pediatric patients with type 1 diabetes save per year on insulin? To answer this, we analyzed data from 12,000 patients under age 21 years with type 1 diabetes We found that the average patient paid almost $500 per year for insulin in 2018; 1 in 8 paid more than $1,000. Under a $25 national cap per 30-day supply of insulin, we found that 60% of pediatric patients would see lower out-of-pocket spending for insulin. Among this 60%, out-of-pocket spending would decrease on average from $741 to $261, or $481. Under a $100 national cap, 18% of pediatric patients would see lower out-of-pocket spending for insulin. Among this 18%, out-of-pocket spending would decrease on average from $1343 to $786, or $558.  Our study suggests that caps could serve as a useful stop-gap measure while more comprehensive reforms are implemented to address the underlying problem of high insulin prices and to ensure affordable insulin access to all Americans, regardless of whether they have insurance.

Paper Cited: “Potential Change in Insulin Out-of-Pocket Spending Under Cost-Sharing Caps Among Pediatric Patients With Type 1 Diabetes”, JAMA Pediatrics. DOI: 10.1001/jamapediatrics.2020.1065