A new study by researchers at the University of Wisconsin School of Medicine and Public Health and the University of Southern California Schaeffer Center for Health Policy & Economics found that the $35 cap on monthly out-of-pocket costs of insulin for Medicare beneficiaries has led to a significant increase of insulin prescription fills, especially for Black and Latino patients.
“Ensuring access to affordable insulin is critical for promoting health equity given that Black and Latinx individuals, including among Medicare populations, are more likely to suffer from diabetes and experience barriers in accessing diabetes medications, including insulins,” said Dima Mazen Qato, study co-author, and Hygeia Centennial Chair and associate professor in the Titus Family Department of Clinical Pharmacy at the USC Mann School.
To examine the cap’s effectiveness, researchers used data from IQVIA’s National Prescription Audit, which includes mostly a variety of retail pharmacies as well as mail-order and long-term care facility pharmacies. The researchers compared outcomes before the Inflation Reduction Act took effect, from September through December 2022, and after, from January through April 2023, when the cap policy was enacted. The study sample included 14 million insulin fills and compared changes in insulin fills for Medicare Part D enrollees aged 65 to 74 with changes among 60- to 64-year-olds without Medicare insurance.
Rebecca Myerson is the study lead author and assistant professor of population health sciences at the University of Wisconsin School of Medicine and Public Health. “Our analysis suggests that this policy meaningfully reduced the number of Medicare beneficiaries who were not filling their insulin because of the cost – which would have potentially put their health at risk,” Myerson tells Madison365. “This is a policy that we thought had the potential to do two things, first save money for people who are taking insulin, help them receive their prescription for a lower out-of-pocket cost, and then maybe expand the pool of people who are able to afford insulin, which would help people from skipping the recommended dosage of their medication.
“Our analysis examines changes in insulin fills between the end of one calendar year and the beginning of the next,” Myerson adds. “This may be particularly important for patients because that’s when deductibles reset, and so a lot of patients do have to pay out-of-pocket for their care.”
Myerson explains how the data trends show a drop in insulin prescriptions filled from January 2022 to December 2022, as people had to pay more for refills. The study suggests the average number of monthly fills with out-of-pocket expenses less than or equal to $35 grew by over 20,000 for Medicare enrollees. For those without Medicare, over 21,000 people were able to access less expensive insulin fills. Myerson’s comments align with remarks by John A. Romley, study co-author, and associate professor at the USC Sol Price School of Public Policy and Alfred E. Mann School of Pharmacy, who said, “Many Americans are concerned with the cost of insulin because people with diabetes are at great risk of serious health problems, including nerve damage, heart attack and stroke.”
In their analysis, these researchers found that Medicare beneficiaries filled about 50,000 more insulin prescriptions per month that were below $35, and about 20,000 of these fills would not have taken place if not for the policy.