As Insulin Use Rose, So Did Out-of-Pocket Costs

Diabetes patients have been spending increasingly more over time on synthetic insulins

(RxWiki News) Many people with diabetes take insulin, which can help their body process blood sugar. As faster- and longer-acting insulins have been developed, insulin use — and cost — has increased.

For some people with diabetes, taking extra insulin may help the body maintain normal blood sugar levels. Since 1921, when the hormone was found to lower blood sugar, insulin production has advanced. Today, genetically altered insulins called analogs have improved treatment for many.

A new study found that the use of analog insulin has climbed in recent years, along with the cost of insulin prescriptions.

"Ask a doctor about insulin options that may help with diabetes care."

Kasia J. Lipska, MD, an instructor in endocrinology at the Yale University School of Medicine in New Haven, Connecticut, and colleagues sifted through a massive database of insurance claims and found 123,486 patients who filled at least one prescription for insulin between 2000 and 2010.

These researchers calculated that those who filled insulin prescriptions accounted for 9.7 percent of adults with type 2 diabetes in 2000 and 15.1 percent of adults with type 2 diabetes in 2010.

There are three different types of insulin. Animal insulin, derived from cows and pigs, was the first type to be given to humans to control blood sugar. In the past few decades, the use of animal insulin has been largely replaced by “human” insulin and analog insulin.

Human insulin is actually synthetically made in a lab to mimic human insulin. This first man-made insulin was approved by the US Food and Drug Administration (FDA) in the early 1980s. In the 1990s, a new type of synthetic insulin was introduced called analog insulin, which was genetically manipulated to meet specific patient needs.

There are rapid-acting analogs that provide flexible dosing and convenience. There are long-acting analogs that can help prevent nighttime hypoglycemia (when blood sugar levels drop too low).

Analogs are now the main type of insulin used by patients. Dr. Lipska and colleagues found that in 2000, 96.4 percent of adults using insulin filled prescriptions for the human synthetic type. That percentage dropped to 14.8 percent in 2010. On the other hand, 18.9 percent filled prescriptions for insulin analogs in 2000, but that number soared to 91.5 percent in 2010. Note that some patients may have filled prescriptions for both types of insulin.

Throughout the 10 years, animal insulin accounted for less than 1 percent of prescriptions.

As prescriptions have increased, so have patient costs. Dr. Lipska and team discovered that median out-of-pocket costs per prescription for all types of insulin rose from $19 in 2000 to $36 in 2010.

Over the course of the study, extreme hypoglycemic events dipped a bit, but the results were not statistically significant.

“We found a large increase in the prevalent use of insulin analogs among privately insured patients with type 2 diabetes,” the authors concluded. “The clinical value of this change is unclear.”

This study was published June 11 in JAMA. Dr. Lipska reported receiving support from the Centers for Medicare & Medicaid Services, the Pepper Center career development award and a grant from the National Institute on Aging.

Review Date: 
June 10, 2014