The American journal of managed care · 2025
Trends in insulin out-of-pocket costs and use disparities, 2008-2021.
СтатьяПоддержка NIH: внешняя программаПоддержка службы здравоохранения СШАНазвание и аннотация: Перевод в очереди
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Tremblay Elise S, Argetsinger Stephanie, Zhang Fang, Ross-Degnan Dennis, Wharam J Frank
Аннотация
OBJECTIVE: To assess trends in insulin out-of-pocket (OOP) costs, use, and disparities among commercially insured patients from 2008 to 2021.
STUDY DESIGN: Retrospective time series from a national insurance database, with members in all US states, including data from 2008 to 2021.
METHODS: Insulin OOP costs and 30-day equivalent fills per year were quantified among insulin users aged 12 to 64 years, stratified by income (low- vs high-poverty zip code) and health plan type (high-deductible health plans with savings options [HDHP/SO] vs not). Participants were commercially insured insulin users aged 12 to 64 years with at least 1 full enrollment year. Characteristics of interest for disparities analysis included income level (low- vs high-poverty zip code) and health plan type (HDHP/SO vs non-HDHP/SO plan).
RESULTS: After increases in adjusted mean annual insulin OOP costs from 2008 ($221 per non-HDHP/SO member and $313 per HDHP/SO member) to 2014 ($280 and $496, respectively), HDHP/SO members had persistent relative reductions in insulin use. In 2014, HDHP/SO members had 0.17 fewer annual fills, a disparity that increased until 2019 (0.79) before decreasing slightly by 2021 (-0.55). Lower-income members consistently had fewer insulin fills.
CONCLUSIONS: Insulin OOP cost reduction policies would be more efficient if they targeted HDHP/SO plan members and low-income patients.
STUDY DESIGN: Retrospective time series from a national insurance database, with members in all US states, including data from 2008 to 2021.
METHODS: Insulin OOP costs and 30-day equivalent fills per year were quantified among insulin users aged 12 to 64 years, stratified by income (low- vs high-poverty zip code) and health plan type (high-deductible health plans with savings options [HDHP/SO] vs not). Participants were commercially insured insulin users aged 12 to 64 years with at least 1 full enrollment year. Characteristics of interest for disparities analysis included income level (low- vs high-poverty zip code) and health plan type (HDHP/SO vs non-HDHP/SO plan).
RESULTS: After increases in adjusted mean annual insulin OOP costs from 2008 ($221 per non-HDHP/SO member and $313 per HDHP/SO member) to 2014 ($280 and $496, respectively), HDHP/SO members had persistent relative reductions in insulin use. In 2014, HDHP/SO members had 0.17 fewer annual fills, a disparity that increased until 2019 (0.79) before decreasing slightly by 2021 (-0.55). Lower-income members consistently had fewer insulin fills.
CONCLUSIONS: Insulin OOP cost reduction policies would be more efficient if they targeted HDHP/SO plan members and low-income patients.