The increasing cost and access to insulin has become a great concern to individuals with diabetes, as well as all other stakeholders, including families, healthcare providers, insurers, and employers, and the American Diabetes Association (ADA) has now issued a white paper addressing the subject. The paper was published in Diabetes Care.
Between 2002 and 2013, the price of insulin nearly tripled, and there is no alternative medication. “The reasons for this increase are not entirely clear but are due in part to the complexity of drug pricing in general and of insulin pricing in particular,” wrote the authors.
The white paper addresses a number of critical factors associated with the escalating costs, including the regulatory framework for developing biosimilar insulins, clinician prescribing patterns, formulary lists that determine medication coverage, and patient out-of-pocket costs.
The ADA also gives recommendations in their paper for both providers and organizations. One is that providers, pharmacies, and health plans need to discuss cost with patients, and providers should prescribe the lowest-priced insulin that can be effectively and safely used. The list price for insulin products should more closely reflect the net prices, and the current system in general should be less reliant on rebates, discounts, and based that are based on list price.
Undue administrative burdens or excessive costs can hamper access to insulin, and health plans should ensure that these are minimized. There needs to be more transparency throughout the insulin supply chain. The development of more effective insulin preparations needs to be encouraged, and the FDA should continue to streamline the process in bringing biosimilar insulins to market. Organizations such as the ADA need to advocate for access to affordable and evidence-based insulin products for all persons with diabetes.
Cefalu WT, Dawes DE, Gavlak G, et al; Insulin Access; Affordability Working Group. Insulin access and affordability working group: conclusions and recommendations [published online May 8, 2018]. Diabetes Care. doi: 10.2337/dci18-0019