Diabetes Drug Costs

Updated January 6, 2016

Here at DiabetesSelfManagement.com, we often discuss newly developed drugs and treatments for diabetes. In fact, blogger Amy Campbell has written a series on diabetes drugs — including newer options — and recently here at Diabetes Flashpoints, we discussed inhaled insulin. We do, of course, discuss older treatments all the time, but the steady arrival of new diabetes drugs on the market means that these treatments get a lot of ink and pixels.

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The diabetes drug landscape has shifted dramatically since 20 years ago, when insulin and a small group of oral drugs were the only treatments for Type 1 or Type 2 diabetes approved by the U.S. Food and Drug Administration (FDA). The wide array of current options — most of them for Type 2 diabetes — has, however, come at a cost.

The amount of money spent on treating diabetes is substantial and has been rising in recent years, as noted in an article at Kaiser Health News. In 2014, the article notes, per-person spending on diabetes drugs was higher than for any other group of traditional drugs for the fourth straight year. Moreover, fewer than half of these prescriptions were for generic drugs — indicating that newer drugs, as well as insulin, accounted for the bulk of this spending.

According to a study published in 2015 by the Health Care Cost Institute — which the Kaiser article mentions — health-care spending for people with diabetes in 2013 averaged $14,999, compared with $4,305 for people without diabetes, within a group of 40 million people under age 65 with employer-sponsored insurance. Not only were total costs higher, but out-of-pocket costs were also higher for people with diabetes, who spent an average of $1,922 on deductibles and copays, compared with $738 for people without diabetes. The out-of-pocket burden can be even worse for people on Medicare, who must grapple with that program’s coverage gap (“doughnut hole”) for prescription drugs — in 2016, Medicare beneficiaries must pay a higher amount out-of-pocket once their total annual drug spending reaches $3,310, until it reaches $4,850. The gap is shrinking over time thanks to the Affordable Care Act (“Obamacare”).

As the Kaiser article notes, some insurance companies and pharmacy benefit managers are trying to steer patients toward generic drugs before they try a newer, brand-name diabetes drug in an effort to limit costs. It’s difficult to know how many people using newer, more expensive diabetes drugs already tried cheaper generics — or are using both at the same time — and how many never tried a generic. Another reason for the rise in diabetes drug spending, beyond newer drugs, may be that people with diabetes are receiving more aggressive treatment than was previously the norm, resulting in more drugs being used to control blood glucose levels.

What’s your experience with diabetes drug costs — are you spending more out-of-pocket now than you used to? Are you taking any newer, more expensive drugs, regardless of how much you pay out-of-pocket? If so, did you start taking the drug after trying an older drug like metformin? Do you think doctors and insurance companies should steer patients toward cheaper drugs, when possible? Or do you think that newer medicines are likely to work better and are therefore worth the cost? Should the federal government take steps to lower drug costs, such as letting Medicare negotiate directly with pharmaceutical companies? Leave a comment below!

  • Is there not available any low cost schemes where poor citizens can also avail the treatment of their disease?
    Although so many diabetes care equipments like blood glucose monitor, pedometer, lancing device, accuchek strips, etc. are available in the market to prevent diabetes, but mostly the people who belong to poor citizen, can’t afford to prevent their diabetes because it’s medication is too costly.

  • James McDowell

    Why do insurance companies always put insulin in the top tier??

  • Dorcas

    I switched Part D Rx plans this year — ordered my first box of Humalog Kwik pens — and the copay is $210 per box. Help. What are my options? I love the Kwik pens, all the time, but especially for traveling. My manufacturer coupons no longer work since I am on a government insurance program. How can I find assistance to be able to afford the kwikpens and other brandname meds I have no alternative for? Any ideas?