In a recent study presented at the APhA Annual Meeting and Exposition, researchers shed light on the exorbitant out-of-pocket (OOP) spending that many Americans face when purchasing antidiabetic medications.

The study aimed to examine the financial strain on individuals and households, particularly in reaching catastrophic spending levels, defined as when "greater than 40 percent of a household’s non-subsistence income" is spent on healthcare payments.

The findings revealed that in 2020, an estimated 3 million Americans (10.3%) experienced OOP spending for antidiabetic drugs that reached catastrophic levels. When considering OOP spending for all prescription medications throughout the year, this number increased to 4.9 million (16.5%).

Even for those who did not reach catastrophic spending levels, the burden of OOP payments for diabetes medications was substantial. Across the nation, a staggering 23.8 million Americans reported using at least one prescription medication to treat diabetes.

The total OOP payments for antidiabetic medication in this group exceeded $5.2 billion, with insulin alone accounting for 42% or $2.2 billion in 2020.-+

On a per capita basis, annual OOP payments for all prescription drugs among individuals with diabetes were $436, with antidiabetic drugs constituting 41% or $178 per capita. While not classified as catastrophic, these payments could still have a significant impact on the quality of life for individuals, especially considering that 60% of Americans live paycheck-to-paycheck.

The study highlighted the vulnerability of uninsured individuals, as a missed paycheck could likely result in a missed medication payment. Medicaid coverage played a crucial role in reducing the likelihood of reaching catastrophic spending levels, with the odds being 78% less likely for Medicaid recipients.

On the other hand, individuals who paid the full cost of their medication out-of-pocket were 2.5 times more likely to reach the catastrophic spending threshold compared to Medicare beneficiaries.

Despite recent price cuts by pharmaceutical giants Eli Lilly, Novo Nordisk, and Sanofi, the study concludes that the affordability of prescribed medication for persons with diabetes remains a significant challenge for many Americans. The need for complementary medications to safely treat diabetes further emphasizes that there is substantial work to be done to ensure that diabetes care, and healthcare as a whole, is accessible to all.

Compare Diabetes Medicine Prices

The study also underscored the need to address the cost of diabetes medications. While some pharmaceutical companies have pledged to reduce prices, the data shows that significant challenges persist.

Policymakers and stakeholders are urged to continue advocating for solutions that make essential medications, including insulin, more affordable for all individuals, regardless of their financial circumstances. Efforts to compare diabetes medicine prices and implement further reforms are essential to ensure that the financial burden on individuals and households is alleviated, and equitable access to diabetes care is achieved.