A serious condition that frequently requires lifelong management with one or more medications, diabetes impacts more than 10% of Americans, and the number continues to grow as evolving conditions such as prediabetes and metabolic syndrome lead to more diagnoses.
Though lifestyle changes to improve diet and increase physical activity can decrease the risk of developing type 2 diabetes and additional complications from the disease, medication is a major contributor and first line of defense in managing diabetes. From the influence of direct-to-consumer advertising to the new Inflation Reduction Act and insulin rationing, understanding the factors that drive diabetes medication choices is key for self-funded employers trying to untangle the growing impact of these rising costs on their pharmacy benefits plan.
Diabetes medication cost increases are complicated to unravel. The threads include a growth of diabetes in the population, increased diabetes diagnoses during the pandemic, certain diabetes drugs being prescribed off-label for conditions such as weight loss, and providers utilizing more expensive, newer therapies sooner based on recent updates to treatment guidelines.
High-cost prescriptions dominate the airwaves
It’s hard to turn on the TV today without seeing advertisements for high-cost diabetes medications. In 2021, four out of five of the most advertised non-specialty drugs are in the diabetes category, and we see their influence on trend.
These ads work to drive people to the doctor’s office by creating awareness, and they may potentially connect patients with a helpful medication. However, ads could also drive unnecessary utilization, as not every diabetic patient should be on those medications. Plan sponsors bear the cost for these prescriptions beyond the copay — and name-brand drugs can increase employer cost. A prescription for metformin instead of Ozempic, for instance, could save a plan $9.5K a year.
It’s a continuing issue of doctors and patients not knowing the cost of medications. Employers should be aware of the potential impact of these ads on their pharmacy plan, but they should also consult with their employee benefit advisor to ensure they and their members have a sustainable benefit, where people get the medications they need at the most affordable cost.
Insulin rationing and the Inflation Reduction Act
Nearly one in five adults with diabetes — over 1M people — rations their insulin to save money, according to a recent study from the Annals of Internal Medicine. And disturbingly, the practice of rationing was most common with those who have type 1 diabetes — which could lead to even worse health outcomes.
Rationing insulin can be a dangerous, even deadly, solution to the high cost faced by diabetics. The study focused on skipping doses, taking less than needed, or putting off purchasing insulin, but diabetic patients may also skip meals, ration test strips, and avoid regular doctor’s appointments as a means to offset associated costs.
The Inflation Reduction Act, which passed in August 2021, aims to reduce the price of prescription drugs for Medicare recipients. The bill caps the cost of a monthly insulin supply to $35, and it will allow the government to negotiate prices for Medicare on certain high-cost prescriptions. But it does not impact commercial plans.
The impact of the bill will not reach many of those who are at risk for insulin rationing — young adults, the uninsured, and insured members of commercial plans. Working to make medications affordable is a much-needed fix, but the impact of the insulin cap will be limited to Medicare patients.
On top of that, while federal legislation does benefit Medicare members with insulin expenses, insulin may be used in combination with other high-cost treatments that are not subject to legislative price caps. This gap reinforces the need for ongoing awareness and advocacy to ensure patients have access to optimal treatments.
What can be done to help patients struggling with diabetes costs?
Neither employers nor their benefits advisor can control what pharma advertises or how the economy moves, but employers and their members can be armed with information to make smart, affordable prescription and lifestyle choices.
Diabetes patients can benefit from having an expert consult with them on their healthcare journey to help them make better choices today to find better health outcomes in the future, and RxBenefits can continue to advocate for diabetes patients to have access to affordable medications and solutions. Through our partnership with Tria Health, we’re helping patients close the care gap by proactively engaging them with a designated pharmacist as their personal advocate, providing disease education, care coordination, and support.