Switching type 2 diabetics from analogue insulin therapies to human insulin products saves patients money without compromising health, according to new research published in JAMA.
In 2016, Medicare Part D spent more than $4 billion on just one long-acting insulin analogue, wrote lead author by Jing Luo, MD, MPH, of Brigham and Women’s Hospital and Harvard Medical School in Boston, and colleagues.
“These trends are concerning because high prices for insulin often translate into higher out-of-pocket payments for patients with insufficient drug coverage or for Medicare beneficiaries in the Part D coverage gap,” Luo et al. noted.
Another recent study found the rising price of insulin over the last several years has made managing diabetes much more expensive for patients. Recently CMS’ Center for Medicare and Medicaid Innovation (CMMI) announced a new model aiming to lower prescription drug prices at the catastrophic level in Medicare Part D that could save roughly $2 billion, which CMS Administrator Seema Verma noted is a preliminary estimate.
Managed care organization CareMore Health researched insulin spending in 2014 and found many of its members were using insulin analogues that had a high daily injection burden, while also meeting their Medicare Part D coverage gap.
To mitigate this, CareMore spearheaded an intervention program and exchanged analogue insulin therapies for human insulin—a viable initial treatment option for many patients with type 2 diabetes—between February and June of 2015. Patients were incentivized to switch with a $0 copay, compared to the $37.50 in copay for analogue insulin, in addition to out-of-pocket payments if they reached the Part D coverage gap. A coverage gap, also called a donut hole, refers to the temporary limit on what a patient and their plan will pay for drugs each year.
“The goals were to reduce daily injection burden and to delay or avoid the Medicare Part D coverage gap by encouraging members to use a clinically comparable insulin regimen that was less costly,” Luo and colleagues wrote.
The clinical results showed there was a minimal increase in blood sugar (0.14 percent). Additionally, the rate of hospitalizations for hyperglycemic and hypoglycemic incidences did not change after the switch, making human insulin products a viable treatment option for type 2 diabetics.
Interestingly, the clinical results showed little to no difference, though the economic impact was noteworthy. Pre-intervention, monthly expenditures for insulin under Medicare Part D was more than $3.4 million in December 2014, compared to a post-intervention expenditure of $1.4 million in December 2016. Post intervention, analogue insulin spending decreased to $515,875 in December 2016. Additionally, monthly expenditures for human insulin stabilized to $916,826 in December.
Pre-intervention, the researchers found 21 percent of members reached the Medicare Part D coverage gap. By 2016, only 11 percent of members reached the gap—an important economic factor for older Americans.
“On the individual patient level, use of human insulin may minimize out-of-pocket spending, and, on the healthcare system level, it may allow insurers to maximize the value of diabetes care,” wrote Kasia J. Lipska, MD, MHS, of the Yale School of Medicine in New Haven, in a corresponding editorial.
As a senior news writer for TriMed, Subrata covers cardiology, clinical innovation and healthcare business. She has a master’s degree in communication management and 12 years of experience in journalism and public relations.